LIBRARY   OF   ALDES  WILLIAMS 


VOL. 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

LOS  ANGELES 


GIFT 
Gift  of  Mr.   L.A.  Williams 


PSYCHIC  TREATMENT 

OF 

NERVOUS     DISORDERS 


THE  PSYCHIC  TREAT- 
MENT   OF    NERVOUS 

DISORDERS    ::     ::     ::     :: 

(The  Psychoneuroses  and  Their  Moral  Treatment} 


By 
DR.    PAUL    DUBOIS 

Professor  of  Neuropathology  at  the  University  of  Berne 


TRANSLATED  AND  EDITED  ST 
SMITH, ELY  JELLIFFE,  M.D.,  PH.D. 

Visiting  Neurologist  City  Hospital ;  Instructor  in  Matfria  Medica  and  Therapeutics, 
Columbia  University,  New  York 

AND 

WILLIAM  A.  WHITE,  M.D. 

Superintendent  Government  Hospital  for  Insane,  Washington,  D.  C.;  Professor  of 

Nervous  and  Menial  Diseases,  Georgetown  University,  Washington,  D.  C.; 

Professor  of  Menial  Diseases,  George  Washington  University, 

Washington,  D.  C. 


FOURTH  EDITION 


FUNK   &   WAGNALLS    COMPANY 

NEW    YORK    AND     LONDON 


COPYRIGHT,  1905,  BY 

FUNK  &  WAGNAI^S  COMPANY 

[Printed  in  the  United  States  of  A  merica] 

Published  July,  1905 


VJM 


TRANSLATORS'   AND   EDITORS'   PREFACE 

THE  preparation  for  the  American  public  of  a  translation  of 
Professor  Dubois's  "Les  Psychoneuroses  "  has  been  undertaken 
with  tne  conviction  that  its  publication  in  this  country  would 
be  particularly  opportune  at  this  time,  when  the  effect  of  the 
mental  representations  upon  the  bodily  conditions  is  attracting 
so  much  attention  here,  and  when  the  problems  connected 
with  it  are  being  attempted  from  so  many  and  such  various 
points  of  attack.  It  is  a  question  as  alluring  as  it  is  baffling, 
and  it  is  not  easy  to  preserve  toward  it  an  attitude  at  once 
open  and  balanced.  Such  an  attitude,  however,  Professor 
Dubois  has  maintained  from  the  start,  and  to  it  he  owes  the 
exceptionally  convincing  quality  of  his  work. 

Whether  in  the  opening  chapters,  where  he  discusses  the 
fundamental  philosophy  underlying  the  position  which  he 
holds,  or  in  the  latter  portion  of  the  book,  where  he  describes 
so  clearly  and  charmingly  the  exact  methods  by  which  he  has 
won  such  notable  success,  this  sane  and  tranquil  attitude  is 
obvious.  It  is  difficult  to  see  how  one  who  accepts  the  well- 
nigh  axiomatic  premises  with  which  the  author  sets  out  can 
avoid  accompanying  him  quite  to  his  conclusions,  so  logical 
and  inevitable  is  his  progress.  By  the  time  we  reach  the 
specific  instances  which  illustrate  the  power  of  "  moral  ortho- 
pedics," of  "  persuasion,"  and  of  "  education  of  the  reason," 
the  successes  chronicled  there  seem  to  the  reader,  as  to  the 
author,  the  inevitable  result  of  the  "  psychotherapy  "  which 
he  practises. 

The  strong,  optimistic  tenor  of  the  book,  its  simple,  un- 
technical  language,  and  the  directness  with  which  its  phi- 
losophy is  applied  to  life,  make  it  capable  of  becoming  a  vital 
fact,  not  merely  to  physicians,  but  to  every  one  who  has  pon- 
dered on  the  relations  between  the  psychic  and  the  physical  — 
to  every  one,  indeed,  who  honestly  desires  to  keep  down  the 


vi       TRANSLATORS'  AND  EDITORS'  PREFACE 

sum  total  of  needless  suffering  in  the  world.  That  psychic 
disorders  require  psychic  treatment,  that  many  distressing 
and  dangerous  nervous  disorders  are  purely  or  primarily 
psychic — these  are  the  theses  for  which  the  book  contends, 
together  with  the  obvious  completion  of  the  syllogism.  It  is 
safe  to  say  that  not  a  day  passes  in  which  any  one  fails  of  an 
opportunity  to  apply  the  principles  set  forth  by  Professor 
Dubois,  and  it  is  in  the  hope  that  the  publication  of  his  book 
may  promote  the  seizing  of  these  opportunities,  as  well  as  prove 
illuminating  to  some  of  the  most  prevalent  problems  of  the 
practitioner,  that  the  American  edition  has  been  produced. 

Thanks  are  due  to  the  persevering  labors  of  Mrs.  Smith 
Ely  Jelliffe,  who  provided  the  translation  in  large  part,  and  of 
Miss  Grace  Goodale,  who  prepared  the  Index. 

SMITH  ELY  JELLIFFE. 
WILLIAM  A.  WHITE. 
NEW  YORK,  June  17,  1905. 


DR.  DEJERINE'S  PREFACE 

THE  work  of  Professor  Dubois  is  that  of  a  physician  as 
well  as  of  a  psychologist  who  for  a  long  time  has  perceived  the 
important  role  played  by  psychotherapy  in  the  treatment  of 
the  neuroses.  At  a  period  when,  in  spite  of  the  works  of 
Pinel  and  Lasegue,  showing  the  necessity  for  the  adoption  of 
moral  methods  of  treatment  in  the  psychopathies,  physicians 
persisted  in  treating  the  neuroses  solely  by  physical  methods, 
Dubois  has  had  the  merit  of  showing,  in  a  series  of  publications, 
the  primordial  (fundamental),  if  not  unique,  role  which  is 
played  in  the  treatment  of  psychoneuroses  by  what  I  should 
like  to  call  psychic  pedagogy — that  is  to  say,  the  reeducation 
of  the  reason.  He  has  been  the  first  resolutely  to  conduct  all 
his  therapy  in  accordance  with  this  guiding  idea. 

There  is  to  be  found  in  this  volume,  along  with  the  most 
interesting  psychological  considerations,  a  description  of  the 
methods  used  by  the  author  in  his  practise  of  psychotherapy. 
There  are  some  very  beautiful  passages  which  would  not  be 
out  of  place  from  the  pen  of  a  philosopher  or  a  moralist,  the 
perusal  of  which  must  impress  all,  whether  patients  or  phy- 
sicians, who  have  the  desire  to  know  how  and  why  the  psycho- 
neuroses  develop,  and  how  they  may  be  cured.  But  what  is 
most  distinctly  felt  on  reading  these  pages  is  that  they  are  the 
work  of  a  man  with  convictions,  to  whom  one  might  apply  the 
phrase  of  our  old  Montaigne :  "  Here  is  a  book  of  good  faith." 

It  gives  me,  moreover,  all  the  more  pleasure  to  present 
this  book  to  the  French  medical  public  because  the  author  is 
an  old  friend.  In  wishing  him  the  success  which  he  deserves, 
I  only  do  justice  to  the  work  of  a  man  whose  talents  I  esteem 
as  much  as  I  admire  his  character. 

J.  DEJERINE. 
PARIS,  March,  1904. 


AUTHOR'S    PREFACE 

SOME  years  ago  I  received  from  a  young  French  physician 
a  letter,  from  which  the  following  lines  are  an  extract: 

"  The  cure  of  M. has  made  some  stir  in  the  medical 

world  of  X.  Every  one  knows  that  neurasthenia  is  an  essen- 
tially curable  disease,  but  every  one  also  knows  that  the  meth- 
ods which  must  be  employed  to  bring  about  a  satisfactory 

result  are  not  within  the  reach  of  all.  The  case  of  M.  

was  not  easy,  and  the  resources  of  many  of  my  acquaintances 
were  exhausted  in  connection  with  him." 

In  conclusion  my  confrere  asked  my  advice  upon  some 
points,  in  order  that  he  might  obtain  the  same  results  in  his 
medical  practise,  which  he  was  just  beginning. 

I  answered  him  by  a  long  letter,  in  which  I  tried  to  bring 
out  the  peculiarities  of  the  psychic  treatment  which  I  had 
used;  but  I  had  to  point  out  to  my  friend  that  it  was  impos- 
sible for  me  to  condense  in  such  a  way  the  experiences  that 
had  been  gathered  during  more  than  twenty  years,  chiefly 
devoted  to  the  treatment  of  the  neuroses.  It  was  only  by  per- 
sonal conversations  that  he  was  able  to  see  my  views  and  put 
them  into  such  form  that  he  could  use  them  in  his  practise. 

On  the  other  hand,  some  intelligent  patients  among  my 
colleagues,  with  whom  I  have  had  very  friendly  relations,  have 
often  expressed  a  desire  to  read  what  I  had  said  to  them. 

I  have  held  out  for  a  long  time  against  these  friendly 
entreaties.  We  live  in  a  period  of  exact  research,  of  labora- 
tory work,  and  of  statistics  that  are  more  or  less  convincing, 
and  I  can  offer  only  impressions  and  opinions  which  are  based 
upon  what  I  believe  to  be  conscientious  observations,  and  on 
reflections  which  are  forced  upon  me  by  facts,  but  I  do 
not  possess  the  necessary  scientific  reputation  to  insure  their 
acceptance. 

If,  in  spite  of  these  justifiable  fears,  I  dare  to  face  the 
criticism  of  my  colleagues,  it  is  first  because  I  feel  that  I  am 


2  AUTHOR'S   PREFACE 

upheld  by  the  friends  who  have  become  interested  in  my  ideas ; 
but,  above  all,  it  is  because,  in  the  practise  of  my  treatment  by 
psychotherapy,  I  have  had  such  good  and  lasting  results  that 
I  should  like  to  put  into  the  hands  of  young  physicians  the 
instrument  which  I  have  found  so  useful. 

The  correspondence  begun  with  my  young  friend  has  led 
me  to  make  a  resume  of  the  results  of  my  observations.  I  have 
made  them  the  subject  of  lectures  given  to  the  Faculty  of 
Medicine  of  the  University  of  Berne,  and  have  written  them 
out,  not  for  the  public,  but  for  my  confreres,  and  to  them  I 
give  them,  asking  only  a  certain  measure  of  indulgence. 

PAUL  DUBOIS. 
BERNE,  1904. 


TABLE  OF  CONTENTS 


CHAPTER  I 

Modern  Medicine  —  Virchow,  Pasteur,  Lister  —  Conditions  of 
Thought  Thirty  Years  Ago — Progress  of  Surgery,  Bacteriol- 
ogy— New  Orientation  of  Medical  Ideas — Neglect  of  the  Neu- 
roses— Hysteria,  Briquet,  Charcot — The  School  of  Nancy  and 
Hypnotism — Neurasthenia  :  Its  Existence  in  Former  Genera- 
tions   ii 

CHAPTER  II 

Classification  of  the  Neuroses — Psychoneuroses  or  Nervousness — 
Psychic  Origin  of  Nervousness — Tendency  to  Assign  to  it 
Somatic  Causes — Abuse  or  Physical  and  Medicinal  Therapeu- 
tics— Poverty  of  True  Psychotherapy — Mixture  of  Practical 
Materialism  and  Doctrinal  Spiritualism — Obstacles  to  the 
Development  of  Psychotherapy 22 

CHAPTER  III 

Rational  Basis  of  Psychotherapy — Education  of  the  Reason — 
Dualistic  Spiritualism  —  Psychophysical  Parellelism  —  Mgr. 
d'Hulst — Different  Opinions  Concerning  the  Bond  of  Affinity 
between  the  Mind  and  the  Body — Practical  Philosophy 
Founded  on  Biological  Observation — The  Importance  of  the 
Problems  of  Liberty,  of  Will,  and  of  Responsibility  ....  35 

CHAPTER  IV 

The  Problem  of  Liberty — Determinism — Flournoy;  Ernest  Naville 
— Imperious  Character  of  the  Motives  that  Induce  Action — 
Popular  Conception  and  Philosophic  Conception  of  Liberty — 
Our  Slavery  in  the  Presence  of  Our  Innate  and  Acquired  Men- 
tality— Moral  Orthopedia — Uselessness  of  the  Concept:  Will .  47 

CHAPTER  V 

Absolute  Responsibility — Social  and  Moral  Responsibility — Inde- 
pendent Morality:  Reason  is  its  Guide — Gradual  Development 
of  Moral  Sentiments  —  Moral  Conscience  —  Community  of 
Aspirations  among  the  Believers  in  Free  Thought — Search  for 
Happiness:  Depends  on  our  Native  or  Acquired  Mentality — 
Faults  of  Character  or  Disorder  of  the  Mind 58 


4          TABLE  OF  CONTENTS 
CHAPTER  VI 

Difficulties  of  Moral  Orthopedia — Criminality — The  Partisans  of 
Absolute  Responsibility  and  the  Determinists  Remain  Irrecon- 
cilable Adversaries  in  Theory — Possible  Compromise  in  Prac- 
tise— Necessity  of  this  Understanding — The  Role  of  Human 
Justice — Educative  End  of  Repression — Urgent  Reforms  of 
Penal  Laws 70 

CHAPTER  VII 

Monistic  Conception — Passivity  of  the  Organism — Absence  of 
True  Spontaneity — Mechanism  of  the  Reflex — Psychology  is 
Only  a  Chapter  of  Biology — Interpolation  of  Conscious  Acts 
in  the  Reflex  Arc — Mental  States  Have  Always  a  Material 
Substratum — The  Ideogenic  and  Somatogenic  Origin  of  Men- 
tal States — Riciprocal  Influence  which  the  Moral  and  the 
Physical  Exercise  Upon  One  Another — The  Possibility  of  Act- 
ing on  these  Mental  States  by  Physical  Means  and  by  Moral 
Influence;  Efficacy  of  the  Latter So 

CHAPTER  VIII 

Slavery  of  the  Mind  in  the  Presence  of  Certain  Diseases:  General 
Paralysis,  Meningitides,  Epilepsies,  Intoxications — Possibility 
of  Escape  from  It  by  Education  of  the  Moral  Ego — Pinel;  Cur- 
ative Action  of  the  Work  of  Logical  Reflection — The  Difficulty 
of  Psychotherapy  in  the  Vesanias;  its  Efficacy  in  the  Psycho- 
neuroses — Necessity  of  Clear  Ideas  on  the  Genesis  of  these 
Diseases — The  Importance  of  Psychotherapy  in  Every  Prov- 
ince of  Medicine 93 

CHAPTER   IX 

Psychic  Symptoms  of  Nervousness — Psychic  Origin  of  Functional 
Troubles— Every  Organic  Disease  Has  Its  Counterpart  in 
Nervousness — The  Characteristic  Thing  of  Nervous  Cases  is 
Not  Their  Pains,  but  Their  Mentality — Mental  Stigmata:  Sug- 
gestibility, Fatigability — Exaggerated  Sensibility  and  Emotiv- 
ity— Suggestion  and  Persuasion — Suggestibility  in  a  Normal 
State 103 

CHAPTER  X 

Fatigability — Muscular  Fatigue;  Its  Location — Mental  Troubles 
Connected  with  Muscular  Fatigue;  Tissier,  Fere — Psychic  Ele- 
ment of  Fatigue— Conviction  of  Fatigue — Cerebral  Fatigue — 
Ergographic  Curves — True  Fatigue  and  Ordinary  Fatigue— 
Dynamogeny  and  Dynaraophany — Importance  of  these  Ideas 
to  the  Physician  and  the  Educator 120 


TABLE  OF  CONTENTS          5 
CHAPTER  XI 

Sensibility  the  First  Condition  of  All  Physiological  Activity — Sen- 
sation: Its  Psychic  Character — Constant  Influence  of  the  Idea, 
of  Autosuggestions,  on  Our  Various  Sensibilities  to  Physical 
Agents:  Air,  Barometric  Pressure,  Temperature,  Electricity, 
Light,  Food 133 

CHAPTER  XII 

The  Emotions — Physiological  Theory;  Lange,  W.  James,  Sergi — 
Intellectualist  Theory — Cold,  Intellectual  Ideas  ;  Warm  Feel- 
ings— Subconscious  Emotions  ;  Apparent  Automatism  of  the 
Emotional  Reaction — Psychic  Origin  of  Emotion;  Value  of 
this  Conception  for  Treatment — Irrationalism  of  Nervous 
Patients  —  Physical,  Intellectual,  and  Emotional  Fatigue; 
Dangers  of  the  Last — Unhealthy  Impressionability — Tempera- 
ment and  Character 144 

CHAPTER  XIII 

Psychasthenia:  Congenital  and  Not  Acquired — Absence  of  Any 
Dividing  Line  Between  the  Normal  Mental  Condition  and 
Insanity — Clinical  Forms  of  Psychoneuroses — Neurasthenia  : 
Its  Characteristic  Stigmata:  Physical,  Intellectual,  and  Moral 
Fatigability — Exaggeration;  Significant  Contradictions — Men- 
tal Instability — Somatic  Symptoms  Due  to  Fatigue  ....  157 

CHAPTER  XIV 

Hysteria:  Its  Characteristic  Stigma  is  Autosuggestibility — Pas- 
sional Attitudes — Natural  Predisposition — Feminine  Mental- 
ity— Mental  Infantilism  —  Hysteroneurasthenia  —  Traumatic 
Forms— Anesthesias — Hysterical  Fevers 172 

CHAPTER  XV 

Melancholia  —  Danger  of  Suicide — Hypochondria:  Its  Milder 
Forms  Approach  Neurasthenia — Insufficiency  of  Nosographic 
Classifications — Hypochondriacal  Melancholia — Minor  Hypo- 
chondrias— Periodic  Depression  of  Lange 184 

CHAPTER  XVI 

Idea  of  Degeneracy:  Morel  and  Magnan — Mental  and  Bodily  Stig- 
mata— Abuse  of  the  Idea  of  Degeneracy — Human  Imperfec- 
tions :  Physical,  Intellectual,  and  Moral  Malformations  — 
Relationship  of  the  Different  States  of  Disequilibrium — Isolated 
Nervous  Symptoms 198 


6          TABLE  OF  CONTENTS 
CHAPTER  XVII 

The  Therapeutics  of  the  Psychoneuroses — Suppression  of  Actual 
Disorders— Modification  of  the  Mentality  of  the  Subject  to 
Avoid  Recurrences— Religious  Faith;  Suggestions  of  Char- 
latans;  Suggestion  by  Medicines;  Scientific  Suggestion;  Hyp- 
nosis   2°9 

CHAPTER  XVIII 

Rational  Psychotherapy— Its  Efficacy  in  All  Domains  of  Medicine 
— The  Necessity  for  Impressing  the  Patient  with  the  Convic- 
tion of  Cure— Blind  Faith  and  Rational  Faith— The  Persist- 
ence that  is  Necessary  to  Establish  the  Idea  of  Cure— Organic 
Complications— Contrary  Suggestions— Necessity  of  Chang- 
ing the  Mental  State  of  the  Subject— Favorable  Conditions  for 
Attaining  this  End 223 

CHAPTER  XIX 

Weir  Mitchell's  Treatment;  Modifications  which  Ought  to  be 
Made  in  It  in  Order  to  be  Efficacious — Utility  of  the  Measures 
of  Rest  in  Bed — Overfeeding  and  Isolation — Importance  of 
the  Psychic  Factor — The  Treatment  of  Psychoneuroses  Ought 
to  be  a  Cure  of  Psychotherapy  Made  Under  the  Favorable 
Conditions  of  Rest,  Overfeeding,  and  Isolation — Sketch  of  this 
Moral  Influence 235 

CHAPTER  XX 

Various  Symptoms  of  Nervousness — Digestive  Troubles  :  Their 
Frequency — Mental  Anorexia:  Disgusts,  Sensation  of  Restric- 
tion, and  Depression — Stimulation  of  Appetite  by  Psychic 
Means — Gastric  Dyspepsia:  Its  Genesis  and  Its  Aggravation 
by  Autosuggestion — Gastric  Troubles  in  the  Insanities;  Cere- 
bral Affections — Broussais;  Barras — Easy  Diagnosis  of  Ner- 
vous Dyspepsia 249 

CHAPTER  XXI 

Treatment  for  Dyspeptics — Rest,  Isolation,  and  Preparatory  Milk 
Diet— Building  Up  by  Overfeeding — Massage — The  Value  of 
these  Measures — Necessity  of  Inducing  Obedience  by  Persua- 
sion—Results of  the  Treatment  and  Examples 26s 


TABLE  OF  CONTENTS          7 
CHAPTER  XXII 

Influence  of  Mental  Representations  on  the  Intestine — Abuse  of 
the  Word  "Enteritis" — Emotional  Diarrhea — Necessity  of 
Combating  this  Psychic  Sensibility — Fixation  of  Thought  on 
Intestinal  Troubles — Its  Inconveniences — Physiological  Ex- 
periences ;  Pavlow  and  Kronecker — Mucomembranous  Co- 
litis: Its  Habitual  Cause,  Constipation 278 

CHAPTER  XXIII 

Habitual  Constipation — Uselessness  of  Laxatives — Efficacy  of 
Treatment  by  Training — Influence  of  Habit — Outline  of  Pre- 
scriptions Intended  to  Reestablish  the  Intestinal  Function — 
Suggestive  Influence — Psychology  of  Constipated  Patients  .  291 

CHAPTER  XXIV 

Disturbances  of  Circulation — Emotional  Tachycardia — Basedow 
Symptoms — Permanent  Tachycardia  :  Its  Existence  in  the 
Tuberculous — Arythmia:  Intermittent,  Accidental  Murmurs — 
Suppression  of  Cardiac  Disturbances  by  Psychotherapy — Ner- 
vous Dyspnea  —  Convulsive  Cough — Stuttering — Nervous  or 
Hysterical  Aphonia — Mutism 305 

CHAPTER   XXV 

Disturbances  of  Urinary  Functions  — Retention  ;  Phobias — Noc- 
turnal Incontinence  —  Polyuria  —  Pollakiuria  —  Qualitative 
Modifications  of  Urine — Disturbances  of  Sexual  Life  ;  Their 
Frequency  in  the  Psychoneuroses — Sexual  Psychopathy — 
Onanism — Physical  and  Psychic  Influence — Menstruation  and 
Menstrual  Psychoses — Nervousness  at  the  Menopause — The 
Critical  Age — Possibility  of  Psychotherapeutic  Intervention 
in  these  Various  Conditions 319 

CHAPTER  XXVI 

Troubles  with  Sleep — The  Uselessness  and  Dangers  of  Narcotic 
Medication — The  Insufficiency  of  Various  Kinds  of  Hydro- 
therapy — Efficacy  of  Psychotherapy — Causes  of  Insomnia  : 
Physical  Ones,  Too  Vivid  Sensorial  Impressions;  Moral  Ones, 
Intoxications  and  Autointoxications;  Preoccupations  or  Ob- 
sessions— Anxiety  in  Trying  to  Get  to  Sleep — Psychothera- 
peutic Machinery — Creation  of  a  Mental  Condition  Favorable 
to  Sleep — Abuse  of  Medicinal  and  Hydrotherapic  Treatment .  334 


8  TABLE   OF    CONTENTS 

CHAPTER  XXVII 

Various  Nervous  Attacks — Their  Usual  Treatment  by  Antispas- 
modics,  Hydrotherapy,  etc. — Advantages  of  Moral  Treatment 
— Sudden  Cessation  of  Attacks  under  the  Influence  of  Change 
of  Environment — In  Hysteria  Everything  is  Mental,  and  the 
Treatment  Should  be  Psychotherapeutic — Possible  Failures — 
Persistence  of  the  Hysterical  Mentality — Moral  Obstacles  to 
Cure — Spirit  of  Contradiction  —  Self-esteem  —  A  Few  Words 
on  Traumatic  Hysteria 347 

CHAPTER  XXVIII 

Disturbances  of  Motility — Spasms,  Tics,  and  Myoclonias — Inter- 
vention of  Mentality — Professional  Cramps — Influence  of  Un- 
easiness, Timidity — Charcot,  Brissaud,  Meige  and  Feindel — 
Psychomotor  Discipline — Kinesotherapy  and  Psychotherapy 
— Advantages  of  Pure  Psychotherapy  in  Patients  in  whom  the 
Phobic  Element  Predominates 360 

CHAPTER  XXIX 

Conditions  of  Helplessness  in  Various  Motor  Domains — Their 
Psychic  Origin  —  Paraplegia  —  Hysterical  Astasia-abasia  — 
Stasophobic  and  Basophobic  Symptoms  in  the  Course  of  Other 
Psychoneuroses — Example  of  Cure  by  Pure  Psychotherapy  .  374 

CHAPTER  XXX 

Example  of  Psychic  Treatment  in  a  Case  of  Psychoneurosis  with 
Multiple  Symptoms — Nervous  Pains  Cured  by  Suggestion — 
Value  of  Direct  Psychotherapy — Utilization  of  the  Stoic  Idea; 
Seneca — Pelvic  Neuralgia  Cured  by  these  Measures  ....  388 

CHAPTER  XXXI 

Analysis  of  a  Case  of  Hysteria  with  Multiple  Symptoms — Disas- 
trous Effect  of  Wavering  in  the  Diagnosis  and  of  Local  Treat- 
ment— Only  a  Direct  and  Frank  Psychotherapy  Puts  an  End 
to  the  Vagaries  of  the  Disease — Recent  Progress  of  Psycho- 
therapy—Buttersack,  of  Berlin— The  Works  of  D.  P.-E.  Levy, 
of  Paris — The  Education  of  the  Will — Necessity  of  Holding  to 
Psychotherapy  Pure  and  Simple 401 


TABLE  OF  CONTENTS          9 
CHAPTER  XXXII 

Proofs  of  the  Value  of  Moral  Treatment  in  Psychoneuroses — Modi- 
fication of  Mentality  as  the  Result  of  Advice — Relation  of  a 
Case  of  Psychoneuroses  which,  Having  Resisted  Physical  and 
Moral  Cure,  was  Cured  in  a  Single  Day  by  Psychic  Influence 
— Divers  Cases  of  Nervousness,  in  which  the  Cure  has  been 
Obtained  without  Physical  Means  (by  Psychotherapy)  in  the 
Course  of  a  Few  Conversations  .  , 412 


CHAPTER    XXXIII 

Psychotherapeutic  Treatment  Without  the  Intervention  of  Phys- 
ical Measures — Case  of  Neurasthenia  of  a  Melancholic  Nature 
— Cure  and  Relapses — Case  of  Disequilibrium — Suppression 
of  all  Maniacal  Impulsions  by  a  Few  Conversations — Incura- 
bility of  Certain  Psychoneuroses — Mental  Peculiarities  which 
Make  One  Foresee  Failure — Moral  Idiots — Disturbances  of 
Feelings  of  Affection  in  the  Psychoneuroses 425 


CHAPTER    XXXIV 

Etiology  of  the  Psychoneuroses — The  Causes  the  Same  as  those 
of  Insanity — Definition  of  Nervousness — Predisposition,  He- 
redity, and  Natural  Disposition — Relation  of  Nervousness  to 
Physical  Debility — Anemia,  Arthritism  or  Horpetism,  and 
Cholemia — Purely  Somatic  Origin  of  Certain  Psychoneuroses 
— Advantages  of  a  Persevering  Psychotherapy — Necessity  of 
Making  it  Rational 439 


CHAPTER    XXXV 

Conclusions — Views  on  Medicine  in  the  Twentieth  Century — 
Surgery — Internal  Medicine — Medicative  Therapeutics,  Phys- 
iotherapy— Constant  Intervention  of  Psychotherapy  :  Its 
Necessity  in  the  Struggle  Against  the  Psychoneuroses — The 
Precepts  of  Physical,  Intellectual,  and  Moral  Hygiene  .  .  .  451 

INDEX 463 


PSYCHIC    TREATMENT    OF 
NERVOUS  DISORDERS 

CHAPTER   I 

Modern  Medicine — VIrchow,  Pasteur,  Lister — Conditions  of  Thought 
Thirty  Years  Ago — Progress  of  Surgery.  Bacteriology — New  Orien- 
tation of  Medical  Ideas — Neglect  of  the  Neuroses — Hysteria,  Briquet, 
Charcot — The  School  of  Nancy  and  Hypnotism — Neurasthenia:  Its 
Existence  in  Former  Generations 

MODERN  MEDICINE  boasts  of  being  scientific,  and  certainly 
with  reason. 

The  gross  empiricism  and  doctrinal  statements  of  the 
beginning  of  the  nineteenth  century  have  given  place  to  exact 
research  and  the  patient  study  of  facts;  medicine  has  become 
experimental.  Often  a  more  progressive  person  attempts  some 
brilliant  synthesis,  but  his  theoretic  views  are  still  based  on 
facts  that  are  accepted  as  established.  They  are  not  evolved 
in  the  study ;  they  come  from  the  laboratory,  which  everywhere, 
whether  it  be  modest  or  elaborate,  is  an  indispensable  adjunct 
to  the  clinic. 

From  physics,  chemistry,  and  even  mathematics  we  have 
learned  methods  of  work  and  analytical  processes.  The  allied 
sciences  have  furnished  us  with  powerful  aids  to  investigation, 
by  means  of  which  we  have  been  able  to  study  symptoms  and 
make  diagnoses  with  a  precision  that  has  been  hitherto  un- 
known, so  that  each  day  records  a  new  conquest. 

A  brilliant  era  has  already  begun  under  the  influence  of 
pathological  anatomy.  The  microscope  opens  up  new  horizons 
and  permits  the  study  of  the  alterations  of  tissues  in  their  finest 
details.  Cellular  pathology  has  been  born,  and  the  name  of 
Virchow  marks  a  date  that  will  never  be  forgotten  in  the 
history  of  medicine. 


12  PSYCHIC  TREATMENT 

A  little  later  the  genius  of  Pasteur  led  us  in  a  new  direc- 
tion. Our  eyes  were  unsealed,  and  we  were  enabled  to  catch 
a  glimpse  of  the  important  role  that  microbes  play  in  the  eti- 
ology of  a  great  number  of  diseases.  Practical  results  were 
not  expected ;  under  the  stimulus  of  Lister,  surgeons  began  the 
work  of  attacking  the  enemy  before  they  had  even  learned  its 
nature,  and  out  of  this  movement  arose  the  greatest  practical 
discovery  of  the  century,  antisepsis.  The  tendency  to-day  is 
to  give  the  place  of  honor  to  asepsis,  but  the  principle  is  the 
same.  The  object  is  to  protect  the  injured  tissues  from  the 
micro-organisms  which  would  hinder  the  natural  work  of 
healing  and  expose  the  patient  to  the  danger  of  general 
infection. 

I  remember  very  well  the  state  of  mind  with  which  these 
astonishing  discoveries  were  received  some  thirty  years  ago. 
They  excited  general  enthusiasm.  The  younger  generation 
was  carried  away  by  the  powerful  rush  of  ideas,  and  more 
than  one  old  physician  regretted  that  he  was  no  longer  on  the 
school  benches  and  could  not  be  associated  in  this  magnificent 
work. 

But,  as  is  always  the  case  during  these  periods  of  infancy, 
there  were  exaggerations.  Surgery  took  the  first  place;  it 
hesitated  at  nothing.  Operations  that  had  formerly  been  con- 
sidered dangerous  became  possible,  and  one  could  hear  the 
public  exclaim :  Surgery  has  taken  immense  strides,  but  medi- 
cine is  at  a  standstill ;  it  is  to-day  exactly  where  it  was  in  the 
time  of  Hippocrates.  The  watchword  seemed  to  be:  No 
sickness  without  visible  lesions;  behold  your  enemy,  the 
microbe.  Let  us  do  battle  with  knife,  cautery,  and  antisep- 
tics! Since  that  day  surgeons  have  had  for  their  brothers  in 
internal  medicine  a  patronizing  smile  mingled  with  a  little 
disdain,  and  it  was  from  this  period  that  one  dates  their 
tendency  to  make  bold  incursions  into  the  classic  domain  of 
medicine.  Wherever  the  idea  of  operative  intervention  crop- 
ped up  in  their  minds  they  did  not  hesitate  to  act  with  a  con- 
fidence in  the  efficacy  of  their  weapons  that  may,  perhaps,  have 
been  exaggerated. 

I  would  be  lacking  in  perspicacity  if  I  refused  to  recognize 


OF  NERVOUS   DISORDERS  13 

the  good  that  has  resulted  from  this  progress.  I  am  too  skep- 
tical on  the  subject  of  internal  medication  not  to  accept  with 
thanks  the  help  of  the  surgeon,  and  I  believe  that  by  the  con- 
stant working  together  of  physician  and  surgeon  there  can  be 
brought  about  true  progress  which  will  be  of  great  benefit  to 
the  sick. 

But  there  is  a  limit  to  everything,  and  one  often  hears  a 
surgeon  discuss  his  operations  in  a  way  which  shows  that  it 
is  not  always  easy  to  develop  simultaneously  his  manual  dex- 
terity, his  good  sense,  and  his  moral  conscience. 

Bacteriology  continues  to-day  with  its  patient,  useful  work. 
Innumerable  microbes  are  cultivated,  and  a  modern  laboratory 
constitutes  a  regular  infinitesimal  menagerie  of  malignant 
bacilli.  But  not  content  with  putting  them  in  cages  their 
keepers  subdue  them  with  antitoxins  and  serums,  sometimes 
with  curative  and  sometimes  with  preventive  results. 

Finally  the  thyroid  gland,  which  the  surgeons  formerly 
extirpated  as  a  useless  glandular  mass,  without  excretory 
canal  and  without  functions,  has  become  an  important  organ. 
We  attribute  to  it  an  internal  secretion,  and  the  confirmation 
of  this  theory  has  thrown  some  light  on  the  pathogeny  of 
myxedema  and  Basedow's  Disease. 

Here  again  we  find  the  tendency  to  go  to  extremes;  after 
having  seen  microbes  everywhere  we  dream  only  of  internal 
secretions,  and  we  find  ourselves  in  the  fantastic  domain  of 
opotherapy. 

Thus,  encouraged  by  the  certain  therapeutic  action  of  some 
serums,  such  as  that  of  diphtheria  in  particular,  we  have  come 
to  a  conclusion  too  quickly,  and  have  sought  a  panacea  in  sero- 
therapy. It  would  not  matter  if  science  alone  were  compro- 
mised by  these  hasty  generalizations,  for  it  is  by  passing 
through  error  that  the  truth  is  reached.  But  the  sick  have 
suffered  by  them;  they  have  the  right  to  reproach  us  for  our 
lack  of  consideration,  and  often  even  for  our  mercantile  spirit. 

Let  us  not  forget  physical  means  of  treatment,  such  as 
hydrotherapy,  massage,  gymnastics,  and  that  universal  servant, 
electricity.  If  the  chemists  did  not  daily  throw  upon  the 
market  some  new  medications  the  druggists  would  become 


14  PSYCHIC  TREATMENT 

objects  of  pity.  Really  what  astonishes  me  most,  as  I  make 
this  enumeration  of  our  new  means  of  treatment,  is  that  there 
are  any  sick  people  left. 

By  reason  of  these  successive  innovations  the  relation  of 
medical  studies  has  changed.  For  a  long  time  the  interest 
was  centered  first  upon  diseases  with  organic  lesions.  Only 
the  study  of  this  class  of  diseases  seemed  capable  of  satisfying 
the  thirst  for  precision  which  tormented  the  younger  gener- 
ation. Functional  troubles  and  neuroses  were  forgotten,  the 
psychic  side  of  the  human  being  was  neglected;  and  I  might 
almost  say  that  for  a  very  long  time  the  difference  between  the 
veterinarian's  art  and  that  of  the  physician  was  only  one  of 
clientele!  This  is  still  true  to-day. 

However,  this  very  natural  infatuation  did  not  overwhelm 
all  minds,  and  some  distinguished  physicians  continued,  espe- 
cially in  France,  to  devote  their  wisdom  and  persevering  labor 
to  the  study  of  nervous  and  mental  disorders. 

One  of  the  important  neuroses,  hysteria,  had  particularly 
suffered  from  the  neglect  to  which  it  had  been  subjected  by 
the  new  course  of  medical  ideas. 

It  must  be  admitted  that  the  study  of  the  varied  manifes- 
tations of  this  trouble  appeared  discouraging.  The  multiplicity 
and  the  queerness  of  the  symptoms,  as  well  as  their  dependence 
upon  the  imagination,  seemed  to  make  all  attempts  at  classifi- 
cation delusive.  It  appeared  impossible  to  arrive  at  any  clear 
definition  or  to  construct  a  satisfactory  clinical  picture;  one 
was  lost  in  the  details  of  an  interminable  enumeration  of  incon- 
gruous and  incomprehensible  phenomena.  The  practitioner, 
already  ill  at  ease  on  scientific  ground,  undertook  the  treatment 
of  hysterical  cases  only  with  a  certain  repugnance,  the  more 
because  the  troubled  mental  condition  of  his  subjects  often 
made  the  relations  of  the  physician  to  the  patient  very  difficult. 

Briquet,  in  1859,  had  undertaken,  in  a  didactic  work,  the 
classification  of  the  symptoms,  and  sketched  a  complete  noso- 
graphical  picture  of  hysteria ;  but  it  was  reserved  for  Charcot 
to  focus  interest  on  this  difficult  question.  Patient  and  dis- 
creet, he  applied  himself  first  to  the  simple  facts  that  were 
easy  to  analyze  or  to  reproduce  experimentally.  He  passed 


OF  NERVOUS   DISORDERS  15 

over  the  more  complex  problems,  and  from  his  lips  and  his 
pen  hysteria  became  interesting.  It  was  a  pleasure  to  follow 
the  master  over  this  ground  which  he  had  illuminated,  and 
where  he  led  with  so  sure  a  hand. 

The  scholarly  descriptions  of  the  French  master  were 
received  with  enthusiasm.  A  rich  vein  had  been  laid  bare; 
one  could  henceforth  get  to  work  and  bring  to  the  study  of 
the  neuroses  the  precise  methods  of  analysis  of  the  modern 
clinic. 

Curiously  enough,  however,  there  was  some  trouble  in  get- 
ting the  Germans  especially  to  take  these  didactic  descriptions 
seriously.  The  German  clinicians  smiled,  and  insinuated  that 
it  was  necessary  to  go  to  Paris  to  observe  major  hysteria. 
According  to  them  the  robust  wives  of  Germany  did  not  show 
their  nervousness  in  such  extravagant  fashion.  A  matter  of 
race,  of  temperament,  they  said;  the  Latin  race  is  in  its 
decadence ! 

They  have  had  to  retreat  from  this  position  and  to  learn  to 
observe.  Diseases  which  appear  rare  become  frequent  as  soon 
as  one  has  learned  how  to  diagnose  them,  and  to-day  the 
classical  symptoms  of  hysteria  are  described  in  all  countries 
in  almost  identical  terms. 

One  would  almost  have  thought,  however,  that  the  study  of 
the  major  neuroses,  on  account  of  the  psychological  problems 
which  it  raises,  would  be  particularly  interesting  in  Germany, 
the  country  of  profound  and  sometimes  obscure  philosophies. 
On  the  contrary,  however,  it  was  in  France  that  the  clinicians 
applied  themselves  to  the  study  of  nervous  diseases,  and  they 
brought  to  these  researches  such  delicacy  of  psychological 
observation  and  such  clearness  that  the  foreigner  was  pleased 
to  recognize  them. 

But  if  the  clinical  picture  traced  by  the  hand  of  Charcot 
excels  in  the  clearness  of  its  drawing,  this  is  due  in  part  to  the 
didactic  methods  of  the  master.  His  forte  was  to  sketch  the 
chief  symptoms  like  the  master  artist  who,  with  a  few  strokes 
of  his  pencil,  throws  upon  paper  the  whole  physical  and  moral 
personality  of  his  model. 

At  the  same  time,  endowed  with  the  spirit  of  authority,  he 


16  PSYCHIC  TREATMENT 

handled  his  subjects  as  he  would ;  and  without,  perhaps,  taking 
them  sufficiently  into  account,  he  suggested  to  them  their  atti- 
tudes and  their  gestures.  Example  is  contagious  in  the  domain 
of  neurology,  and  in  the  great  hospitals  of  Paris,  at  La  Sal- 
petriere, all  cases  resemble  each  other.  At  the  command  of 
the  chief  of  the  staff,  or  of  the  internes,  they  begin  to  act  like 
marionettes,  or  like  circus  horses  accustomed  to  repeat  the  same 
evolutions.  Actually  one  can  still  find  at  La  Salpetriere  some 
of  these  old  horses  doing  their  turn.  The  dream  or  suggested 
fancy  of  these  poor  patients  has  been  respected,  and  the  exhi- 
bition, given  to  physicians  who  are  strangers,  always  follows 
the  same  program.  The  regularity  of  the  phenomena  observed 
is  due  to  the  suggestion  which  the  physician,  either  voluntarily 
or  involuntarily,  exercises. 

Under  Charcot  this  pseudoexperimental  study  impelled  the 
observer,  as  it  were,  to  create  hysteria  and  to  give  to  it  the 
complete  reality  of  a  morbid  entity;  to-day  at  La  Salpetriere, 
as  elswhere,  they  imagine  that  they  can  cure  at  the  same  time 
that  they  are  studying  the  symptoms. 

The  influence  of  suggestion  upon  the  development  of  symp- 
toms has  been  brought  to  light  particularly  by  the  work  done 
by  the  school  of  Nancy  on  suggestions  made  in  the  hypnotic 
sleep  or  the  waking  state.  These  experiences,  repeated  every 
day  in  all  countries,  have  shown  that  man  in  his  normal  state 
is  much  more  credulous  than  he  supposes  himself  to  be — in 
fact,  that  he  is  suggestible  in  the  highest  degree. 

The  ^doctrines  of  the  observers  at  Nancy  have  spread  in 
spite  of  the  definite  opposition  of  Charcot  and  his  pupils.  At 
La  Salpetriere,  in  short,  to  be  hypnotizable  was  to  be  hysterical, 
sick.  It  was  in  the  subjects  attacked  by  major  hysteria  that 
Charcot  succeeded  in  provoking  by  different  means  catalepsy, 
anesthesia,  and  somnambulism. 

When  Liebault  and  Bernheim  succeeded  in  producing  sleep 
in  a  large  number  of  non-hysterical  patients,  when  they  were 
able  to  reproduce  in  healthy  persons  the  curious  experiences 
brought  about  by  somnambulism,  they  were  just  a  little  bit 
embarrassed  at  Paris.  It  was  still  worse  when  Bernheim 
declared  that  the  hypnotic  sleep  was  nothing  but  the  result  of 


OF  NERVOUS   DISORDERS  17 

suggestion,  that  he  could  obtain  it  in  ninety  per  cent,  of  the 
patients  in  the  hospitals  without  the  aid  of  magnetic  passes, 
without  staring  at  any  brilliant  object,  merely  by  verbal 
suggestion. 

It  was  plainly  necessary  to  give  up  the  idea  that  suggesti- 
bility was  a  symptom  of  disease  and  to  be  considered  as  an 
indication  of  a  true  hysterical  condition;  it  had  to  be  frankly 
recognized  that  a  healthy  man  is  suggestible  enough  to  accept 
in  broad  daylight,  in  a  few  seconds,  the  suggestion  of  sleep, 
and  that  in  the  resulting  hypnotic  state  he  can  often  be,  at 
pleasure,  rendered  insensible  to  pin  pricks,  plunged  into  cata- 
lepsy, and,  finally,  made  to  accept  suggestions  of  complete 
forgetfulness  on  waking. 

It  was  easy  also  to  see  that  suggestibility  is  more  pro- 
nounced in  the  sane.  The  autosuggestions  of  the  hysterical 
and  the  fixed  ideas  of  the  insane  often  make  these  patients 
refractory  to  outside  suggestions. 

It  is  enough,  to  be  convinced  of  these  facts,  to  pass  a  few 
hours  at  Nancy.  But  here  one  comes  across  the  susceptibility 
of  the  medical  fraternity,  the  rivalries  of  the  schools — I  was 
going  to  say  of  the  cliques,  according  to  the  jargon  of  the 
disrespectful.  At  Paris  they  pretend  to  ignore  Nancy.  Can 
any  good  come  out  of  Nazareth?  And  while  physicians  all 
over  Europe  were  following  with  interest,  believing  in  these 
experiences  that  were  conclusive  by  their  very  simplicity,  at 
Paris  they  were  talking  of  the  "  minor  hypnotism  "  of  Nancy ! 

I  had  the  pleasure  of  spending  a  day  at  Nancy  in  1888,  and 
what  I  saw  in  a  few  hours,  under  the  kindly  direction  of  Pro- 
fessor Bernheim,  has  sufficed  to  dissipate  my  last  doubts,  and 
to  make  me  set  out  more  resolutely  than  ever  along  the  path 
of  psychotherapy,  in  which  I  had  walked  but  timidly  before. 

Since  then,  nevertheless,  I  have  resolutely  and  completely 
turned  my  back  upon  professional  hypnotizers;  I  have  pre- 
served a  very  vivid  memory  of  the  things  I  saw,  and  a  profound 
gratitude  to  the  investigators  who  have  clearly  shown  the 
immense  influence  of  suggestion. 

I  had  at  this  time  a  talk  with  Bernheim  to  learn  how  he 
happened  to  take  up  hypnotism.  He  replied  in  these  words: 


18  PSYCHIC  TREATMENT 

"  As  professor  of  the  clinic  I  read  Charcot's  descriptions  with 
enthusiasm  and  tried  to  reproduce  the  phenomena  observed  at 
La  Salpetriere.  I  did  not  half  succeed,  often  not  at  all.  It 
was  in  vain  that  I  brought  pressure  to  bear  upon  the  eyeballs 
of  patients  or  surprised  them  by  making  a  terrible  noise ;  they 
wouldn't  go  into  a  cataleptic  state.  I  was  not  able  to  get  the 
contracture  by  pressing  on  the  ulnar  nerve,  and  I  was  a  little 
bit  ashamed  of  my  lack  of  ability.  I  then  heard  some  one  speak 
of  Doctor  Liebault  who,  they  said,  plunged  his  patients  into 
an  hypnotic  sleep,  and  I  had  the  curiosity  to  be  present  at  his 
experiments.  I  found  in  his  office  several  persons  in  the  hyp- 
notic state,  some  sleeping  in  a  natural  position  and  others 
fixed  in  cataleptic  attitudes.  I  was  able  to  satisfy  myself  that 
anesthesia  could  be  produced  in  these  subjects,  and  to  study, 
under  the  direction  of  a  physician  who  was  convinced  of  it, 
the  very  strange  phenomena  of  hypnotism. 

"  Still  quite  skeptical,  I  made  some  attempts  upon  an  inmate 
of  an  insane  asylum;  then  on  the  different  patients  of  my 
service.  Faith  came  to  me,  and  with  it  suggestive  authority; 
to-day  I  can  obtain  a  result  by  a  simple  verbal  suggestion  nine 
times  out  of  ten." 

The  facts  are  there;  they  are  undeniable;  they  can  not  be 
ignored  by  those  who  are  interested  in  nervous  pathology ;  yet, 
nevertheless,  to-day  one  still  sees  treatises  on  hysteria,  the 
authors  of  which  seem  to  ignore  absolutely  the  discoveries 
at  Nancy. 

Also,  in  discussing  the  subject  with  one's  confreres,  even 
with  those  who  are  not  bound  down  by  any  theories  of  their 
own,  one  is  surprised  to  see  how  few  can  go  to  the  end  of 
their  logic  and  recognize  this  fundamental  fact  of  human 
suggestibility. 

Since  the  works  of  G.  Beard,  a  new  nervous  disease  has 
been  imported  from  America,  and  seems  to  be  propagated  like 
an  epidemic.  The  name  of  neurasthenia  is  on  everybody's 
lips ;  it  is  the  fashionable  disease.  But  I  am  mistaken,  the  dis- 
ease is  not  new;  it  is  the  name  by  which  it  is  known  that  is 
changed.  It  used  to  be  described  under  the  name  of  hypo- 
chondria, or  melancholia ;  often  it  was  confused  with  hysteria. 


OF  NERVOUS   DISORDERS  19 

For  the  public  it  was  nervous  troubles,  moods,  or  excess  of 
nervous  excitement.  In  fact,  physicians  had  often  attempted 
to  make  of  this  nervous  condition,  which  is  now  called  neuras- 
thenia, a  separate  disease,  and  had  given  it  successively  such 
names  as  nervous  weakness,  irritable  weakness,  general  neu- 
ralgia, spinal  irritation,  cerebrocardiac  neuropathy,  nervous- 
ness, and  neurosis. 

It  is  possible  that  this  affection  may  have  become  more 
frequent  under  the  influence  of  modern  life,  but  it  must  not 
be  forgotten  that  we  now  designate  by  this  name  a  combina- 
tion of  symptoms  known  through  all  time,  and  which  are  for 
the  first  time  grouped  together  as  a  whole.  A  morbid  entity 
had  thus  been  created,  and  nothing  is  more  quickly  adopted  in 
medicine  than  a  new  name.  It  is  a  label  that  permits  us  to 
classify  symptoms  without  making  it  necessary  to  study  them 
very  carefully.  You  see  with  what  facility  we  have  learned 
to  use  the  word  influenza.  It  saves  us  a  great  deal  of  mental 
labor,  and  allows  us  to  make  a  diagnosis  without  racking  our 
brains. 

But  this  easy  method  of  classifying  disease  has  its  incon- 
venient side,  and  we  sometimes  find  ourselves  facing  our 
patients  in  a  very  difficult  position,  when  the  so-called  influenza 
becomes  tuberculosis,  meningitis,  or  typhoid  fever,  and  we  are 
reduced  to  the  unpleasant  expedient  of  making  lame  excuses. 

An  old  practitioner  who,  after  sixty  years  of  practise,  had 
completely  retained  his  memory  and  his  talent  for  observation, 
once  said  to  me  in  consultation:  "At  the  beginning  of  my 
career,  I  noticed  absolutely  the  same  nervous  troubles  that  you 
sum  up  in  this  word  neurasthenia,  and,  it  seems  to  me,  just 
as  frequently  as  to-day.  When  the  mental  condition  was  dis- 
turbed, so  that  the  patient  was  sad  or  uneasy,  we  spoke  of 
melancholia  or  hypochondria,  but  if  the  functional  troubles 
seemed  to  exist  alone,  we  did  not  dream  of  grouping  these 
symptoms  together;  our  diagnosis  was  cephalalgia,  rachialgia, 
gastric  or  intestinal  dyspepsia,  etc.,  and  we  attacked  each  one 
of  these  symptoms  separately.  You  have  been  able  to  discern 
the  bond  that  connects  these  divers  troubles  one  with  the  other, 
and  to  grasp  the  mental  condition  of  the  patient.  This  is  what 


20  PSYCHIC  TREATMENT 

gives  you  the  sensation  of  being  face  to  face  with  a  disease 
newly  created  in  its  entirety,  as  it  were,  by  the  conditions  of 
modern  life." 

At  the  beginning  of  the  nineteenth  century  the  celebrated 
Swiss  physician,  Tissot,1  described  carefully  these  nervous 
conditions,  and  indicated  the  causes,  both  physical  and  moral, 
that  brought  them  on. 

It  is  enough  to  read  the  Traite  sur  les  gastralgies,  et  les 
enteralgies  nerveuses  of  Barras  2  to  be  convinced  that  there  is 
nothing  new  under  the  sun,  and  that  our  ancestors  possessed, 
like  ourselves,  the  peculiar  mental  conditions  that  we  now  rec- 
ognize as  playing  such  a  decisive  role  in  the  etiology  of  the 
various  neuroses.  Neurasthenia,  unnamed,  existed  as  hypo- 
chondria, melancholia,  and  hysteria.  The  leaping  and  dancing 
(gyratory)  epidemics,  the  acts  of  sorcery,  the  practise  of  exor- 
cism of  the  middle  ages  show  rather  that  the  generations  that 
preceded  us  were  infinitely  more  susceptible  than  we  are  to-day. 
Insufficiently  restrained  by  reason,  the  mental  representations 
acquired  an  incredible  acuteness,  and  went  as  far  as  halluci- 
nation and  the  state  of  delirium  in  persons  who  hitherto  had 
appeared  sane.  Modern  hysteria  is  very  modest  and  demure 
compared  with  the  mental  states  revealed  in  Demoniaques  dans 
I'art  by  Charcot  and  Paul  Richer,  and  the  Bibliotheque  diabo- 
lique  of  De  Bourneville. 

If  Neurasthenia,  this  twin  sister  of  Hysteria,  has  passed  by 
and  scarcely  been  perceived,  it  is  because  she  has  been  evolved 
in  a  much  less  dramatic  manner.  She  is  more  individual,  less 
contagious,  and  she  does  not  lead  up  to  a  loss  of  reason. 

Life  has  to-day  become  much  more  complex ;  it  exacts  more 
of  us,  more  of  our  cerebral  activity ;  it  lays  bare  our  weaknesses. 
On  the  other  hand  we  have  become  more  tender  and  more 
interested  in  our  ills,  and  modern  medicine  regards  the  well- 
being  of  each  one  of  us  with  much  more  solicitude  than  ever 
before. 


»  CEuvres  computes  de  Tissot.   Nouvelle  edition.    Published  by  M.  P.  Tissot.   Paris, 
1820,  t  IX. 

1  Traitts  sur  les  getstralgies  et  les  enttralgies  ou  maladies  nerveuses  de  testomac  et  de 
rintestin,J.    P.  T.  Barras.    Third  edition.    Paris,  1829. 


OF  NERVOUS   DISORDERS  21 

We  no  longer  tie  our  hysterical  patients  to  the  stake:  we 
nurse  them;  we  do  not  load  poor  fools  with  chains:  we  give 
them  ample  freedom  in  comfortable  asylums;  we  do  not  leave 
our  neurasthenics  to  themselves,  we  do  not  let  them  founder 
as  though  they  were  abject  wrecks  of  humanity:  but  we  give 
them  moral  support  in  order  to  make  of  them  useful  members 
of  society. 

In  spite  of  the  bitter  struggle  for  existence,  a  sentiment  of 
altruism  pervades  humanity.  We  all  work  for  the  good  of 
all.  It  is  only  when  we  begin  to  gather  up  all  the  wrecks  of 
life  that  we  stop  to  count  them,  and  that  is,  in  a  large  measure, 
why  they  seem  so  numerous  to-day. 

I  do  not  pretend  to  decide  here  in  a  few  words  such  a  diffi- 
cult question  as  that  of  determining  whether  there  are  to-day 
more  fools  and  neurotic  people  than  in  other  days.  But  I 
can  not  fail  to  recognize  the  march  of  human  progress  and  the 
conquests  of  physical  hygiene.  I  can  not  believe  that  mental 
hygiene  is  marching  in  the  opposite  direction,  and  I  have 
unshaken  confidence  in  the  very  slow  but  continuous  develop- 
ment of  our  mentality. 


22  PSYCHIC  TREATMENT 


CHAPTER   II 

Claiiification  of  Neuroses  —  Psychoneuroses  or  Nervousness  —  Psychic 
Origin  of  Nervousness — Tendency  to  Assign  to  it  Somatic  Causes — 
Abuse  of  Physical  and  Medicinal  Therapeutics  —  Poverty  of  True 
Psychotherapy  —  Mixture  of  Practical  Materialism  and  Doctrinal 
Spiritualism  —  Obstacles  to  the  Development  of  Psychotherapy 

IT  is  in  the  class  of  neuroses  that  hysteria  and  neuras- 
thenia are  placed,  and  it  is  of  these  neuroses  that  we  think, 
first  of  all,  when  treatment  by  suggestion  or  psychotherapy  is 
spoken  of.  But,  as  Axenfeld  says,  "  the  entire  class  of  neu- 
roses has  been  based  on  a  negative  conception ;  it  was  born  on 
that  day  when  pathological  anatomy,  having  undertaken  to 
explain  disease  by  changes  in  the  organs,  found  itself  brought 
face  to  face  with  a  certain  number  of  morbid  states  for  which 
no  reason  could  be  found." 

The  number  of  neuroses  ought,  therefore,  to  diminish  with 
the  progress  of  pathological  anatomy;  for  just  as  soon  as  a 
lesion  is  discovered  that  satisfactorily  explains  the  symptoms 
observed  during  the  lifetime  of  the  patient,  the  disease  should 
be  stricken  from  the  list  of  neuroses,  and  in  such  cases  an 
anatomico-pathological  name  is  apt  to  take  the  place  of  the 
clinical  one. 

Nothing  is  more  vague,  however,  than  the  definition  of 
neuroses,  and  when  one  attempts  to  make  a  classification  one 
finds  himself  in  the  midst  of  insurmountable  difficulties.  What 
can  be  done  with  this  artificial  group  of  sensory  neuroses  in 
which  have  been  thrust  pell-mell  various  hyperesthesias  and 
anesthesias,  the  former  symptomatic,  and  due  to  lesions  of  the 
nerves  that  are  either  well  recognized  or  highly  probable,  the 
latter  dependent  on  a  general  nervous  condition?  Of  what 
advantage  is  it  to  construct  a  large  group  of  motor  neuroses, 
bringing  together  contractures,  spasms,  the  various  paralyses 


23 

and  tremors,  and  then  forcing  into  this  list  paralysis  agitans, 
or  Parkinson's  Disease? 

In  each  one  of  these  pathological  conditions  clinical  analy- 
sis ought  to  be  carefully  made.  In  the  greater  number  of 
acute  and  stubborn  neuralgias  and  in  the  various  paralyses 
marked  lesions  will  be  found. 

We  should  not  be  in  too  great  a  hurry  to  describe  a  disease 
as  "  nervous,"  and  if  we  are  often  obliged  to  do  so  it  is  because 
we  have  proof  that,  along  with  the  local  symptoms,  there  are 
more  central  symptoms,  a  general  neurotic  condition.  In  oppo- 
sition to  the  neuroses  with  localized  peripheral  symptoms,  the 
name  of  central  neuroses  and  general  or  complex  neuroses  is 
given  "  to  those  that  are  characterized  by  simultaneous  dis- 
orders of  sensation,  of  movement,  and  of  intelligence,  and 
which,  by  the  great  extent  of  the  symptoms  and  by  their 
multiplicity,  reveal  an  undoubted  affection  of  the  nervous  cen- 
ters "  (Axenfeld  et  Hurchard). 

In  spite  of  all  the  restrictions  that  have  been  made,  the 
class  of  neuroses  is  still  too  large,  and  the  classic  treatises  upon 
the  subject  put  into  this  class  diseases  which  have  nothing  to 
do  with  it. 

It  is  no  longer  permissible  to  leave  tetanus  in  this  group, 
since  it  is  due  to  a  pathogenic  micro-organism  acting  directly 
upon  the  nerves.  We  must  give  up  the  name  of  eclampsia, 
a  vague  term  applied  to  epileptiform  convulsions,  whether  they 
are  due  to  intoxication  or  to  cerebral  lesions.  I  do  not  hesi- 
tate to  strike  from  the  list  of  neuroses,  in  the  strict  sense  of 
the  word,  epilepsy,  or,  rather,  the  epilepsies.  Epileptoid  crises, 
with  real  loss  of  consciousness,  may  occasionally  occur  with- 
out any  known  cause,  or,  under  the  influence  of  moral  emotion, 
in  persons  afflicted  by  hysteria  or  neurasthenia,  but  they  are 
rare  and  transient  symptoms.  Confirmed  epilepsy,  most  often 
incurable  or  persistently  rebellious,  presents  various  cerebral 
changes. 

It  is  not  necessary  to  wait  to  discover  a  single  specific 
lesion.  The  epileptic  crisis  is  only  a  symptom,  and  may,  per- 
haps, be  ascribed  to  lesions  varying  in  their  nature  and  course. 
A  very  narrow  line  divides  the  "  morbus  sacer  "  or  the  "  sacred 


24  PSYCHIC  TREATMENT 

disease"  from  Jacksonian  epilepsy.  The  surgeons  know  so 
much  about  it  that  they  feel  authorized  to  step  in  when  medical 
treatment  proves  of  no  avail,  and  they  go  groping  around, 
blindly  searching  for  some  sort  of  a  lesion;  often  they  have 
no  other  end  than  to  relieve  the  brain  of  an  abnormal  intra- 
cranial  pressure  which  is,  however,  for  the  most  part  purely 
hypothetical.  In  spite  of  the  studies  of  Chaslin,  confirmed 
from  various  sources,  which  prove  the  existence  of  a  cortical, 
neuroglial  sclerosis,  the  pathological  anatomy  of  epilepsy  can 
not  be  considered  as  an  established  fact. 

I  do  not  ignore,  on  the  other  hand,  the  loose  bond  which 
binds  epilepsy  to  migraine,  connecting  the  former  with  the 
neuroses  and  the  latter  with  the  insanities.  In  theory  it  is 
difficult  to  set  forth  any  clear  ideas  upon  the  subject.  But 
when  in  practise  we  make  a  diagnosis  of  epilepsy  we  feel  the 
seriousness  of  the  situation,  we  are  seized  by  the  idea  of  its 
more  or  less  complete  incurability.  In  the  migraines  and  neu- 
roses, on  the  other  hand,  the  prognosis  is  less  harsh.  We  dare 
to  tell  our  patients  frankly  what  the  trouble  is,  whereas  we 
should  hesitate  to  let  the  fatal  word  "  epilepsy  "  fall  from  our 
lips.  This  shows  how  far  removed  this  terrible  disease  is  from 
migraine. 

The  common  chorea,  or  St.  Vitus'  dance,  may,  if  one  wishes, 
be  kept  in  the  class  of  neuroses.  It  may  a  priori  be  affirmed 
that  it  is  not  due  to  any  profound  anatomical  changes,  as  it  is 
easily  cured  in  a  very  short  space  of  time.  But  it  is  what  we 
might  call  a  typical  walking  disease,  of  short  duration,  affect- 
ing particularly  children  of  the  female  sex.  Its  relations  with 
rheumatism  and  affections  of  the  heart  are  undeniable.  There 
have  been  found  in  autopsy  various  cerebral  lesions  which  may, 
however,  be  secondary,  and  English  physicians  have  been 
almost  ready  to  attribute  chorea  to  innumerable  capillary 
emboli  involving  the  optostriate  bodies.  We  also  find  that 
chorea  does  not  derive  any  great  benefit  from  treatment  by 
psychotherapy,  while  it  is  benefited  by  rest. 

The  cases  in  which  a  psychic  influence,  particularly  imita- 
tion, plays  a  prominent  role  (as  in  epidemics  of  chorea)  have 
nothing  whatever  to  do  with  the  chorea  of  Sydenham,  and 


OF  NERVOUS   DISORDERS  25 

ought  to  be  attributed  to  hysteria.  The  fact  that  intense 
emotion  can  act  as  a  determining  cause  of  chorea  should  not 
be  used  to  classify  the  disease  among  the  neuroses.  One  may 
meet  the  same  etiology  in  paralysis  agitans,  in  Basedow's  dis- 
ease or  exophthalmic  goitre,  and  even  epilepsy.  Constant  le- 
sions of  the  nervous  system  have  never  been  found  in  these 
diseases,  but  the  very  rebellious  nature  of  these  affections  and 
their  frequent  incurability  leads  us  to  think  of  structural 
changes  in  the  nerve  cells,  even  tho  it  may  have  been  a  moral 
emotion  that  had  been  the  first  cause  of  the  attacks. 

I  have  said  that  we  must  successively  erase  from  the  list 
of  neuroses  all  the  affections  of  which  the  anatomist  is  able  to 
discover  the  cause.  One  might  thus  come  to  the  conclusion 
that  the  word  neuroses  is  useful  only  as  a  temporary  classi- 
fication, and  that  it  is  destined  to  disappear  from  medical 
terminology. 

In  short,  when  pathological  anatomy  discovers  a  lesion,  a 
focus  of  inflammation,  a  hemorrhage,  a  thrombosis,  and  when 
chemical  analysis  discloses  a  condition  of  intoxication,  we  no 
longer  speak  of  neuroses,  even  tho  the  symptoms  might  have 
been  essentially  "  nervous."  We  thus  recognize  the  first  cause 
of  the  clinical  syndrome  in  the  various  somatic  affections, 
syphilis,  tuberculosis,  arteriosclerosis,  alcoholic  intoxication, 
uremia,  etc.  These  conditions  do  not  exist  in  the  affections 
which  we  always  call  neuroses,  or,  as  I  propose  to  do,  phycho- 
ncuroses,  even  when  we  succeed  in  revealing  the  cellular 
changes  which  have  produced  the  nervous  or  mental  trouble. 
Just  here  we  find  ourselves  face  to  face  with  a  fundamental 
factor:  the  influence  of  the  mind  and  of  mental  representations. 
The  affections  of  the  psychic  life  are  no  longer  simply  sec- 
ondary and  determined  by  a  primary  change  of  cerebral  tissue, 
as  in  general  paralysis  and  other  diseases  of  the  brain.  The 
source  of  the  trouble  is,  on  the  contrary,  psychic,  and  it  is  the 
ideation  which  causes  or  harbors  functional  disorders.  One 
could  boldly  classify  such  neuroses  along  with  the  insanities 
and  designate  them  under  the  name  of  psychoses.  Theoretic- 
ally I  do  not  hesitate  to  affirm  that  nervousness  in  all  its  forms 
is  a  psychosis.  But  practically  this  appellation  has  great  draw- 


26  PSYCHIC  TREATMENT 

backs.  First  of  all,  it  hurts  the  feelings  of  the  neuropaths. 
We  accept  the  term  nervous  diseases  without  any  sense  of 
shame,  but  we  do  not  like  to  be  characterized  as  psychopaths. 
It  is  good,  however,  to  separate  from  the  confirmed  psychoses 
those  mild  psychoses  which,  as  we  shall  see  later,  differ  but 
very  slightly  from  the  normal  state.  The  former,  the  vesa- 
nias  or  insanities,  call  forth  a  much  more  unfavorable  prog- 
nosis, and  their  treatment  more  often  demands  a  sojourn  in 
the  institutions  for  the  insane. 

The  psychopathic  states  of  which  we  speak  are  milder; 
they  are  compatible  with  family  and  social  life;  the  patient 
does  not  go  to  a  professional  alienist,  he  seeks  help  from  his 
ordinary  physician  or  from  the  neurologist.  For  such  affec- 
tions I  have  used  the  term  psychoneuroses;  it  separates  them 
from  the  properly  called  insanities,  while  at  the  same  time 
indicating  the  psychic  nature  of  the  trouble.  The  second  part 
of  the  word  indicates  those  functional  nervous  troubles  which 
accompany  the  psychopathic  state.  The  only  inconvenient 
thing  about  the  word  is  that  it  is  heavy  and  lacks  euphony. 
I  shall  also  often  use  the  word  nervousness.'  It  prejudices  no 
one,  and  can  not  in  any  way  hurt  the  natural  susceptibility  of 
patients. 

Having  eliminated  the  neuroses  which  are  probably  somatic 
in  origin,  I  only  keep  in  this  group  of  psychoneuroses  the 
affections  in  which  the  psychic  influence  predominates,  those 
which  are  more  or  less  amenable  to  psychotherapy;  they 
are :  neurasthenia,  hysteria,  hysterical  neurasthenia,  the  lighter 
forms  of  hypochondria  and  melancholia,  and  finally  one  may 
include  certain  conditions  of  very  serious  disequilibration  bor- 
dering on  insanity. 

If,  for  the  convenience  of  speech,  I  use  the  common  term 
nervousness,  I  by  no  means  intend  to  suppress  the  clinical 
names  consecrated  by  usage.  They  are  titles  which  always 
serve  to  distinguish  the  form  which  the  nervous  troubles  take. 
But  I  insist  at  the  start  on  the  impossibility  of  tracing  the  exact 
boundary  line  between  neurasthenia,  hysteria,  and  the  hypo- 
chondriacal,  and  melancholic  states. 

It  is  to  these  psychoneuroses,  to  this  nervousness,  that  the 


OF   NERVOUS   DISORDERS  27 

treatment  by  psychotherapy  is  particularly  applicable.  It  is 
in  this  domain  that  we  witness  a  slow  but  continual  transfor- 
mation of  our  medical  ideas  full  of  import  to  practical  medicine. 

Nervousness  is  a  disease  preeminently  psychic,  and  a  psy- 
chic disease  needs  psychic  treatment. 

This  is  the  conception  that  a  physician  should  have  in  mind 
is  he  wishes  to  undertake  the  treatment  of  nervous  diseases  with 
success.  These  psychoneuroses  are  frequent,  they  are  often 
very  serious,  and,  much  more  than  organic  troubles,  they  can 
destroy  the  happiness  of  individuals  and  of  families.  The  phy- 
sician who  interests  himself  in  the  mental  life  of  his  patients, 
who  paints,  as  it  were,  the  secrets  of  their  souls,  is  moved  by 
the  suffering  which  he  sees ;  he  sincerely  pities  these  unfortu- 
nate beings  and  sympathizes  with  them.  Bodily  illness,  how- 
ever painful  it  may  be,  seems  to  him  less  cruel  than  these  psy- 
choneuroses which  attack  the  personality,  the  very  ego. 

The  patients  themselves  are  aware  of  this  change  in  their 
mental  condition,  and  often  envy  all  sorts  of  people  who  are 
suffering  even  with  painful  diseases,  but  whose  mental  condi- 
tion is  not  affected. 

To  add  to  the  misfortune,  nervous  patients  are  often  mis- 
understood. They  keep  up  an  appearance  of  good  health  for 
a  long  time;  they  show  very  great  variations  in  their  dispo- 
sitions, to-day  suffering  martyrdom  and  to-morrow  able  to  take 
up  their  work  with  a  certain  briskness. 

Their  relatives,  even  the  most  loving  and  best  meaning,  do 
not  know  what  to  think  of  these  fitful  changes.  They  get  into 
the  habit  of  reproaching  the  patients  for  their  laziness,  their 
caprices,  their  lack  of  energy.  Their  encouragements  are 
taken  in  the  wrong  spirit  and  only  serve  to  increase  the  irri- 
tability, the  sullenness,  and  the  sadness  of  these  poor  nervous 
people. 

The  overwhelming  influence  of  emotions  of  all  kinds  on 
the  development  of  these  psychoneuroses  is  perfectly  obvious. 
But,  alas,  the  great  majority  of  physicians  go  about  as  tho 
they  had  never  noticed  it ! 

They  are  so  impressed  with  their  role  of  physician  to  the 
body  that  they  are  always  hunting  among  the  organs  of  the 


28  PSYCHIC   TREATMENT 

abdomen  for  the  cause  of  all  these  psychic  and  nervous 
troubles. 

The  uterus  has  had  the  honor  of  being  most  frequently 
under  suspicion,  particularly  when  the  question  concerns  an 
hysterical  form  of  nervousness.  The  etymology  of  the  word 
has  contributed  to  keep  up  these  etiological  ideas ;  the  associa- 
tion of  ideas  is  so  easily  formed  in  our  heads,  especially  when 
the  ideas  are  unpleasant,  that  the  word  brings  up  the  idea. 
But  if  so  much  persistence  has  been  shown  in  incriminating 
the  uterus  it  is  because  hysteria,  at  least  in  its  convulsive 
forms,  is  observed  chiefly  among  women,  and  because  it  often 
culminates  during  those  periods  of  life  when  some  delicate 
function  (puberty,  the  menstrual  flow,  menopause,  various 
changes  in  the  uterus  and  its  adnexa)  is  accomplished  in  the 
genital  organs. 

There  are  evidently  relations  there  which  it  would  be  wrong 
to  neglect.  But  there  is  a  vast  difference  between  this  etio- 
logical idea,  which  recognizes  the  possibility  that  the  phenom- 
ena of  the  sexual  life  may  be  an  exciting  cause,  and  the  ancient 
idea,  which  is  always  being  revived,  "  that  the  most  frequent 
causes  of  hysteria  are  the  deprivation  of  the  pleasures  of  love, 
the  vexations  in  connection  with  this  passion,  and  the  derange- 
ments of  menstruation." 

As  Briquet  has  said,  the  treatise  of  Louyer-Villirmay  which 
contains  this  statement,  as  clear  as  it  is  exaggerated,  seems  to 
date  rather  from  the  middle  ages  than  from  1816. 

But  it  is  the  same  false  idea;  as  with  scandal,  some  frag- 
ment always  persists,  and  I  often  hear  from  the  lips  of  prac- 
titioners, both  old  and  young,  the  aphorism:  " Nubat  ilia  et 
inorbits  effugiet!"  (Let  her  marry  and  the  disease  will  dis- 
appear). 

When  the  existence  and  frequency  of  male  hysteria  had 
been  duly  proved,  the  partisans  of  the  genital  origin  of  hys- 
teria were  in  no  wise  nonplussed.  Was  there  not  in  the 
mysterious  sense  awakening  in  boys,  in  onanism,  in  sexual 
excesses  of  all  kinds,  and  in  malthusian  practises,  sufficient 
cause  to  explain  the  genesis  of  hysteria  and  neurasthenia? 

Later  it  was  the  digestive  organs  that  were  dwelt  upon. 


OF  NERVOUS    DISORDERS  29 

The  tendency  was  toward  intoxications  by  the  products  of 
imperfect  digestion.  Everybody  was  seized  with  attacks  of 
dilatation  of  the  stomach,  of  gastroptosis,  of  enteroptosis,  or, 
more  generally,  of  organoptosis.  They  could  hardly  keep  from 
putting  the  kidney  back  into  its  niche  and  lifting  up  the  in- 
testinal organs  bodily.  They  had  recourse  to  dry  diet,  to 
massage,  to  medicines  that  toned  up  the  muscular  walls  of  the 
stomach,  and  to  intestinal  antisepsis.  At  last  the  surgeons 
offered  their  radical  aid  and  took  upon  themselves  the  respon- 
sibility of  reducing  the  stomach  to  more  suitable  proportions. 

Nervousness  was  brought  into  line  with  gout,  and  the  bold 
statement  was  made  that  nervousness  was  arthritis.  To-day 
it  is  cholemia — that  explains  everything. 

Traumatism,  exhaustion,  and  I  know  not  what,  have  been 
accused  of  being  sufficient  to  cause  nervousness  in  all  its  forms. 
The  title,  neurasthenia  of  chronic  fatigue,  has  been  promul- 
gated, and  complete  rest,  not  only  for  several  weeks,  which 
would  be  useful,  but  for  months  and  years,  has  become  the 
only  expedient  in  health  for  nervous  patients.  It  has  been  the 
practise  to  stimulate  energy  by  douches,  by  electric  currents, 
by  massage,  by  dry  friction,  and  by  bicycling.  The  nerves 
have  been  toned  up  by  glycerophosphates,  neurosine,  injections 
of  sequardine,  or  by  artificial  serums;  we  have  even  seen  it 
done  by  salt  solution.  This  reminds  me  of  a  very  suggestive 
advertisement  found  on  the  fourth  page  of  a  journal :  Phys- 
ical and  mental  health  may  be  recovered  by  the  use  of  cocoa 
and  oatmeal. 

But  one  might  say  only  physicians  with  no  experience  and 
little  psychology  could  arrive  at  such  inane  conclusions.  Not 
at  all ;  the  specters  of  retroversion,  of  dyspepsia,  of  atrophic 
gastritis,  of  the  dilatation  of  the  stomach,  of  enteroptosis,  of 
cholemia,  still  haunt  the  mind  of  the  majority  of  physicians. 
There  are,  moreover,  physicians  and  professors  whose  clientele 
brings  them  into  constant  relationship  with  neurotic  patients, 
and  who  are  every  day  called  upon  to  give  their  advice,  who 
deny  this  simple  idea  of  the  psychic  origin  of  nervousness. 

When  I  say  that  they  deny  this  fundamental  idea  I  am 
going,  perhaps,  a  little  too  far ;  but,  at  all  events,  they  forget  it 


30  PSYCHIC   TREATMENT 

at  the  moment  when  it  would  be  most  useful  for  them  to 
remember  it — that  is,  when  they  are  explaining  to  their  patients 
the  measures  that  they  are  to  take. 

I  have  had  under  my  eyes,  through  the  medium  of  my 
patients,  a  great  many  prescriptions  proceeding  from  the  best- 
known  men  of  the  medical  profession,  specialists  in  neurology 
and  psychiatry,  and  I  have  been  astonished  at  the  poverty  of 
their  psychotherapy.  After  having  read  on  the  one  hand  the 
descriptions  of  the  disease  in  which  the  author  very  carefully 
insists  on  modifications  of  the  mental  condition,  I  find  on  the 
other  hand  only  the  most  foolish  therapeutic  indications,  baths, 
douches,  rubbings,  injections  of  strychnine,  and  the  inevitable 
bromide. 

These  prescriptions  seemed  to  me  so  out  of  accord  with 
the  premises  that  I  had  thought  that  the  author  had  not 
intended  to  write  down  the  psychotherapeutic  part  of  his  con- 
sultation, but  had  touched  upon  this  subject  in  conversation. 
The  patients,  however,  assured  me  that  they  had  received  no 
advice  of  this  kind  whatsoever. 

There  is,  nevertheless,  some  progress,  and  during  the  last 
few  years  I  have  noticed  several  prescriptions  where,  at  the 
end"  of  the  page,  after  cold  water,  or  hot  water,  after  the 
bromide  or  the  trional,  was  written :  moral  treatment. 

At  last,  I  said  to  myself,  here  it  is;  and  I  questioned  my 
patients  upon  the  oral  interpretation  which  had  been  given  to 
these  words.  "  But  nothing  was  said  to  me  about  it,  nothing 
at  all;  the  only  thing  that  was  said  was  that  moral  treatment 
was  necessary,  and  after  that  I  was  allowed  to  go  away."  This 
is  the  reply  that  I  have  received  from  these  patients  who  have 
literally  run  all  over  Europe  to  find  a  cure. 

At  last,  quite  recently,  I  saw  some  ladies  who  had  sampled 
psychotherapy  in  all  its  purity,  and  whose  fixed  ideas  had  been 
studied  by  the  methods  of  physiological  psychology.  But  the 
interest  that  was  shown  was  of  too  scientific  a  nature,  and  the 
patients  were  given  to  understand  that  they  were  nothing  but 
mad  people.  To  study  patients  is  not  to  cure  them. 

But  you  forget  us,  the  hypnotizers  will  say ;  yes,  we  agree 
on  this  point,  nervousness  is  psychic  in  its  nature,  and  our  pro- 


OF   NERVOUS   DISORDERS  31 

ceedings  are  psychotherapeutic  par  excellence.  In  the  twink- 
ling of  an  eye,  whether  in  the  hypnotic  sleep,  in  hypotaxia  of 
the  slightest  nature,  even  in  the  state  of  being  wide  awake,  we 
juggle  the  autosuggestions  of  our  patients  as  a  juggler  would 
his  little  balls,  and  we  make  them  well. 

I  never  forget  our  modern  successors  of  Mesmer,  but  their 
case  is  more  serious,  and  I  will  take  it  up  when  I  analyze  the 
therapeutic  measures  for  overcoming  nervousness. 

How  is  it  that  physicians  find  it  so  difficult  to  recognize  the 
mental  nature  of  psychoneuroses  ?  How  is  it  that  they  do  not 
think  to  combine  hygienic  measures,  which  are  often  very  use- 
ful, with  the  necessary  moral  treatment? 

It  is,  as  I  have  hinted,  because  our  medical  education  impels 
us  to  look  for  the  lesion  to  prove  any  organic  changes.  The 
brain  interests  us  only  when  there  is  hyperemia  or  anemia, 
hemorrhage  or  thrombosis,  meningitis  or  tumors.  When  the 
brain  is  only  affected  in  its  functions  we  abandon  the  ground 
to  the  alienist. 

But  physicians  in  asylums  see  the  most  severe  forms  of  the 
psychopathies,  the  insanities,  and,  if  their  studies  render  them 
particularly  apt  in  psychological  analysis,  it  must  be  admitted 
that  their  influence  is  not  as  strong  as  could  be  desired.  They 
live  a  little  apart,  overburdened  with  professional  duties,  and 
write  but  little.  Instruction  in  psychiatry  is  not  sufficiently 
followed,  and  many  young  physicians  enter  upon  their  prac- 
tise quite  unable  to  recognize  the  first  stages  of  a  melancholia 
or  to  discover  a  general  paralysis  under  the  deceptive  mask 
of  neurasthenia. 

Often,  too,  the  alienists  submit  too  passively  to  the  influ- 
ence of  the  medical  clinic.  Certainly  they  are  in  the  right 
path,  when,  armed  with  the  microtome  and  the  microscope, 
they  investigate  the  changes  in  the  nerve  centers ;  they  are 
right  when  they  study  the  chemistry  of  the  organism,  and  apply 
the  exact  clinical  methods  of  modern  medicine  to  the  study  of 
mental  diseases.  They  can  not  go  too  far  along  these  lines,  but 
under  the  condition  that  they  do  not  forget  psychology  and  the 
undeniable  influence  of  the  mental  over  the  physical.  Narcot- 
ics play  too  important  a  role  in  psychiatry,  and  often  the  right 


32  PSYCHIC   TREATMENT 

word  or  a  rational  suggestion  will  replace  to  advantage  the  use 
of  morphine,  chloral,  or  sulphonal. 

I  know  well  enough  that  the  inmates  of  asylums  are  often 
too  disturbed  in  mind  to  obey  any  outside  suggestion,  and  I 
do  not  ask  that  the  alienist  should  attempt  to  argue  away  by 
convincing  syllogisms  the  fixed  ideas  of  a  paranoiac  or  the 
delirium  of  a  maniac. 

But  one  sometimes  sees  psychiatrists  using  narcotic  medi- 
cations and  remedies  to  soothe  their  patients,  and  hydrothera- 
peutic  methods  in  cases  of  simple  neurasthenia  or  hysteria  with 
hypomelancholic  symptoms.  A  heart-to-heart  talk  with  these 
patients  would  be  worth  considerably  more  to  them  than  the 
baths,  the  douches,  or  the  chloral. 

It  has  now  become  absolutely  necessary  to  extend  the 
course  of  instruction  in  psychiatry  and  to  allow  students  to 
enter  the  insane  asylums.  In  short,  there  ought  to  be  more 
place  given  in  medical  studies  to  psychology  and  philosophy. 

We  examine  our  patients  from  head  to  foot  with  all  our 
instruments  of  diagnosis,  but  we  forget  to  cast  a  single  glance 
at  their  combined  physical  and  moral  personalities.  By  reason 
of  plunging  with  such  vigor  into  the  details  we  neglect  the 
tout  ensemble,  and  we  fall  into  a  stupid  materialism  which  has 
nothing  to  do  with  the  so-called  materialistic  doctrines  or  with 
positivism  and  determinism. 

Do  not  be  carried  away,  young  people!  Do  not  abandon 
scientific  ground,  do  not  believe  in  the  bankruptcy  of  science ; 
continue  to  study  man  with  all  the  precision  of  modern  biology, 
but  do  not  forget  that  the  brain  is  the  organ  of  thought,  and 
that  there  'is  a  world  of  ideas. 

There  is  in  this  very  generation  a  strange  mixture  of 
thoughtless  materialism,  and  a  spiritualism  that  it  still  more 
unthinking. 

In  the  practise  of  medicine  it  is  this  narrow  materialism 
that  reigns.  It  is  by  no  means  the  attribute  of  brilliant  minds, 
or  of  thinkers  who  dare  to  submit  the  beliefs  which  have  been 
inculcated  in  them  to  the  criticism  of  reason ;  one  does  not 
need  to  look  for  it  among  the  adepts  of  positivism  or  deter- 
minism. It  is  rigorously  adhered  to,  on  the  other  hand,  by 


OF  NERVOUS    DISORDERS  33 

physicians  who  are  satisfied  with  the  routine  of  their  clientele, 
to  those  who  are  wearied  by  any  thought  which  does  not  per- 
tain to  medical  or  physical  therapeutics.  These  physicians  are 
only  too  happy  to  cure  by  means  of  their  prescriptions,  and 
their  practical  materialism  gets  along  very  well  with  those  who 
are  content  with  a  narrow  spiritualism,  the  fruit  of  an  educa- 
tion to  which  they  take  care  to  add  nothing  new. 

A  real  difficulty  hinders  many  physicians  who  would  have 
recourse  to  treatment  by  psychotherapy.  They  have  recog- 
nized the  insufficiency  of  their  therapeutic  measures,  and  often 
they  see  very  clearly  in  what  direction  they  ought  to  turn  their 
efforts.  But  it  is  an  educative  work  that  must  be  undertaken, 
and  we  are  by  no  means  prepared  for  it  by  the  lessons  of  the 
schools. 

We  are  equipped  to  recognize  the  smallest  functional  troub- 
les of  the  organism  of  the  human  animal.  We  have  been 
taught  how  to  handle  the  various  drugs,  and  we  have  become 
somewhat  familiar  with  the  action  of  cures  by  altitude,  hydro- 
therapy,  electricity,  and  massage.  Surgery,  which  attracts  a 
student  by  the  clearness  of  its  teachings  and  the  unquestioned 
efficacy  of  its  intervention,  has  given  us  still  more  powerful 
weapons.  On  leaving  the  hospital  the  young  physician  throws 
himself  into  his  career  with  perfect  confidence ;  he  believes 
himself  armed  from  head  to  foot.  He  quickly  perceives,  alas ! 
that  he  is  not  very  often  asked  to  perform  a  brilliant  operation 
or  an  exquisitely  careful  dressing,  that  he  can  satisfy  only  a 
limited  number  of  his  patients  with  his  prescriptions.  He  finds 
himself  disarmed  before  the  nervous  patients  who  soon  encum- 
ber his  office. 

But  what  can  be  done?  He  follows  the  regular  order. 
After  having  listened  with  a  distracted  ear  to  the  troubles  of 
his  patients,  he  examines  them,  and  proves  with  very  little 
difficulty  that  their  organs  are  sound.  Then  he  draws  out  his 
note-book  and  prescribes :  Bromide  of  potassium.  At  the 
next  consultation  this  will  be  bromide  of  sodium,  or,  perhaps, 
the  syrup  will  be  changed.  At  last  he  has  recourse — oh,  ad- 
mirable idea ! — to  the  combination  of  the  three  bromides ! 

Not  being  cured,  the  discouraged  patient  turns  to  some 


34  PSYCHIC   TREATMENT 

other  confrere  who,  delighted  by  the  preference  just  shown 
him,  listens  a  little  longer,  examines  him  with  a  little  more 
patience ;  he  reflects,  passing  his  hand  over  his  anxious  brow. 
Ten  to  one  he  will  end  by  prescribing  a  bromide,  or  at  least 
cacodylate  of  soda! 

There  are  many  who  have  practised  these  deceptions  in  their 
own  clientele.  They  ought  to  have  said  as  I  do:  Is  there 
really  nothing  better  to  be  done? 


OF  NERVOUS   DISORDERS  35 


CHAPTER    III 

Rational  Basis  of  Psychotherapy  —  Education  of  the  Reason  —  Dualistic 
Spiritualism  —  Psychophysical  Parallelism — Mgr.  d'Hulst— Different 
Opinions  Concerning  the  Bond  of  Affinity  between  the  Mind  and 
the  Body — Practical  Philosophy  Founded  on  Biological  Observation 
—  The  Importance  of  the  Problems  of  Liberty,  of  Will,  and  of 
Responsibility 

THERE  is  something  further  and  better  to  do,  but,  to  be 
efficacious,  the  treatment  of  psychoneuroses  must  be — and  I 
can  not  repeat  it  too  often — psychic  before  anything  else. 

The  object  of  treatment  ought  to  be  to  make  the  patient 
master  of  himself;  the  means  to  this  end  is  the  education  of 
the  will,  or,  more  exactly,  of  the  reason. 

But,  it  will  be  said,  this  declaration  is  frankly  spiritualistic 
in  its  nature.  Thus  to  give  the  first  place  to  the  moral  influ- 
ence over  the  physical  is  to  return  to  the  dual  spiritualism  of 
philosophy,  it  is  to  fall  back  to  the  nosographical  point  of  view, 
in  the  narrow  conception  of  neuroses  considered  as  diseases 
without  physical  foundation,  morbi  sine  materia. 

I  repudiate  both  these  reproaches. 

The  study  of  biology  brings  before  us  a  constant  parallel- 
ism between  psychic  phenomena  and  cerebral  functions. 

The  most  ardent  defenders  of  spiritualism  do  not  dream  of 
combating  this  statement.  They  easily  find,  among  Protestant 
writers,  thinkers  ready  to  accept  these  premises,  but  their  tes- 
timony may  appear  open  to  suspicion;  it  is  tainted  with  bold 
inquiry.  I  prefer  to  draw  from  a  more  orthodox  source. 

A  Catholic  prelate,  Mgr.  d'Hulst,1  expresses  himself  very 
clearly  on  this  subject: 

"  We  have  all  been  brought  up  to  admire  a  doctrine  of 
which  the  author  is  M.  de  Bonald,  but  the  inspirer  Descartes : 

1  M.  d'Hulst,  Melanges  philosophiques.  Recueil  efessais  consacrSs  d  la  defense  du 
spirititalisme,  etc.  Paris.  Ch.  Poussielgue,  1892. 


36  PSYCHIC  TREATMENT 

The  soul  is  an  intelligence  served  by  the  organs.  The  least 
fault  of  this  definition  is  its  great  incompleteness. 

"  The  intelligence  is  served  by  the  organs,  served,  yes,  with- 
out doubt,  but  also  it  is  subject  to  them.  It  is  true  that  every 
master  of  a  household  is  more  or  less  subject  to  his  servants. 
"  But,  by  making  up  his  mind  to  serve  himself,  he  could 
free  himself  from  this  dependence. 

"  The  soul  has  no  such  resource.  On  the  contrary,  its 
dependence  goes  still  further. 

"  If  it  were  only  a  question  of  the  lower  part  of  the  psychic 
life,  such  as  sensation,  or  even  perception,  one  could  say : 

"  The  soul  depends  upon  the  organs  in  all  the  operations 
which  have  their  origin  outside  the  body.  But  in  its  own  life, 
intellectual  operations,  it  is  master  and  not  servant,  it  does  not 
depend  upon  the  body.  Unfortunately  for  the  theory,  it  does 
not  go  as  far  as  this. 

"  Even  in  an  act  of  the  purest  intelligence  there  is  a  neces- 
sary, an  important,  cooperation  of  the  organs. 

"  The  brain  works  in  the  skull  of  the  thinker.  There  are 
cellular  vibrations  in  the  cerebral  cortex.  To  render  these 
possible  there  is  a  flow  of  blood  that  is  more  abundant  as  intel- 
lectual effort  is  more  intense ;  there  is  an  elevation  of  tempera- 
ture as  a  result;  in  short,  there  is  a  combustion  of  organic 
material. 

"  The  more  the  mind  thinks  the  more  the  brain  burns  its 
own  substance.  And  it  is  thus  that  working  with  one's  head 
causes  a  sensation  of  hunger  quite  as  much,  if  not  more,  than 
muscular  work." 

It  is  not  necessary  to  say  that  the  philosophical  theologian 
gets  away  from  his  premises  in  his  subsequent  considerations, 
but  the  thesis  of  concomitance  is  put  very  succinctly. 

Mgr.  d'Hulst  is,  however,  very  courageous.  Not  only  does 
he  attack  with  cut  and  thrust  his  adversaries,  the  materialists, 
but  without  ceremony  he  abuses  those  who  would  seem  to  be 
his  natural  allies,  the  spiritualists  of  the  Cartesian  type.  He  ac- 
cuses them  of  having  leanings  toward  materialistic  pretensions. 

But,  after  having  indicated  in  such  clear  terms  the  depen- 
dence of  the  soul  on  the  body,  he  faces  about  and  reproves 


OF   NERVOUS   DISORDERS  37 

the  animism  of  the  scholars,  the  doctrine  of  the  spirit  as  dis- 
tinct from  matter.  Let  us  see: 

"  Matter  is  not  devoid  of  activity,  but  it  is  not  autonomous. 
It  does  not  act,  it  reacts. 

"  The  moral  being  acts,  it  feels  its  autonomy,  its  power  to 
act,  and  even  when  it  reacts  (which  is  generally  the  case),1 
it  puts  into  its  reply  to  the  stimulus  from  without  something 
that  was  not  contained  in  the  demand." 

That  is  what  I  can  not  see.  This  autonomy  of  the  moral 
being  is  apparent.  The  psychic  reactions  are  always,  and  not 
only  generally,  determined  by  stimuli  coming  from  outside 
under  some  form  or  other.  It  is  these  which  provoke  asso- 
ciation of  ideas.  One  can  say  of  man  that  he  does  not  act, 
but  reacts. 

It  is,  therefore,  logical  to  admit  that  he  could  not  have  any 
psychic  manifestations  without  concomitant  cerebration,  with- 
out physiochemical  modifications  of  the  brain  cells,  without 
organic  combustion.  One  might  say,  by  slightly  changing  the 
terms  of  a  celebrated  aphorism,  that  there  is  nothing  in  the 
mind  which  is  not  in  the  brain,  "  Nihil  est  in  intellectu  quod 
non  sit  in  ccrebro." 

It  is  often  said  that  the  biologist  must  necessarily  feel  him- 
self checked  at  this  proof  of  parallelism,  of  the  concomitance 
of  the  two  phenomena,  and  that  he  is  prevented  from  pushing 
his  investigations  any  further.  He  is  refused  this  right  under 
the  pretext  that  it  is  not  his  business  to  stray  into  the  domain 
of  metaphysics.  It  is  on  the  basis  of  the  heterogeneity  of  the 
moral  world  and  the  material  world  that  all  bonds  of  causal  con- 
nection between  thought  and  cerebral  activity  are  repudiated. 

It  seems  to  me  that  this  draws  the  confines  of  scientific 
induction  a  little  too  closely. 

Without  doubt  there  is,  between  conscious  acts  and  the 
physical  state  of  the  brain,  an  abyss  which  appears  to  us 
impassable.  We  can  not  in  any  wise  conceive  how  the  physical 
work  of  the  brain  cells  can  engender  a  sensation  or  give  birth  to 
an  idea.  We  can  say,  with  Du  Bois-Reymond,  "  ignorabimus  " 


1  The  italics  are  mine. 


38  PSYCHIC   TREATMENT 

(we  shall  not  know),  or,  rather,  so  as  not  to  speak  for  the  fu- 
ture, "  ignoramus  "  (we  do  not  know). 

But  the  heterogeneity  that  we  admit  subsists  in  the  spirit- 
ual hypothesis.  Logically  it  hinders  us  just  as  much  from 
explaining  the  evident  influence  of  the  soul  over  the  body  as 
from  proving  the  material  origin  of  the  movements  of  the  soul. 

The  plain  fact  is  there ;  the  concomitance  exists,  it  is  recog- 
nized by  everybody.  For,  when  we  have  a  constant  paral- 
lelism between  two  phenomena,  however  different  they  may 
appear  to  us,  we  have  to  choose  between  the  two  following 
hypotheses : 

Either  there  is  a  bond  of  cause  and  effect  between  these 
two  concomitant  phenomena,  or  else  they  are  both  dependent 
upon  a  third  factor. 

This  third  hypothesis  makes  us  think  of  the  predestined 
harmony  of  Leibnitz,  which  assumes  that  the  established  con- 
comitance was  foreordained  by  the  Divine  Being.  In  this 
conception  there  is  no  causal  relation  between  the  prick  and 
the  pain  which  follows  it;  the  latter  is  born  spontaneously  in 
our  soul  at  the  precise  moment  when  we  are  pricked.  Let  us 
slide  over  this  point  lest  we  endanger  our  reason ! 

If,  leaving  the  follies  of  logic  aside,  we  build  up  just  as 
strange  conceptions,  good  sense  restrains  us  and  makes  us 
prefer  the  other  conclusion,  that  which  admits  a  causal  relation 
between  two  parallel  phenomena. 

But  that  is  not  all ;  it  must  be  determined  in  what  sense  this 
relation  exists. 

Here  we  find  ourselves  in  the  position  of  idealists  between 
the  dualistic  spiritualists  and  the  materialists. 

Renewing  the  idea  of  the  Greek  sage,  Parmenides,  the  Irish 
philosopher,  Berkeley,  has  held  that  only  our  sensations  and 
our  mental  representations  exist,  that  that  is  all  that  we  can 
know,  and  that  it  is  not  permitted  for  us  to  conclude  that  there 
is  a  material  reality  of  things. 

These  premises  are  obviously  impregnable.  In  short,  we 
live  only  by  sensations,  and  it  is  impossible  to  prove  that  they 
correspond  to  a  reality. 

But  these  seem  to  me  mere  witticisms.    There  is  no  reason 


OF   NERVOUS   DISORDERS  39 

why  we  should  consider  ourselves  as  subject  to  hallucination ; 
we  distinguish  carefully  between  the  mistakes  of  delirious  peo- 
ple and  the  .vidently  psychic  statements  of  the  healthy  indi- 
vidual. Altho  to  see  a  stick  and  to  feel  pain  may  be  pure 
sensations,  we  have  no  doubt  whatsoever  of  the  material  quali- 
ties of  the  stick,  nor  the  existence  of  the  rascal  who  strikes  us. 

If  by  a  species  of  mental  gymnastics  we  can  raise  ourselves 
to  these  heights,  the  majority  of  thinkers  prefer  to  remain  on 
more  solid  ground.  They  will  find  it  more  rational  to  estab- 
lish the  relation  in  the  inverse  sense — first  of  all  to  admit  the 
existence  of  ourselves  and  of  the  exterior  world ;  then  they 
will  consider  thought  as  the  product  of  cerebral  activity. 

But  let  us  leave  to  metaphysicians  the  task  of  following  out 
this  analysis  and  of  taking  up  the  problem  of  transcendental 
philosophy.  It  is  not  very  probable  that  they  will  reach  con- 
clusions that  will  be  acceptable  to  all  minds. 

In  practical  life,  especially  in  the  domain  of  medical  obser- 
vation, the  moral  and  psychic  life  presupposes  the  integrity  of 
the  brain,  and  we  admit  that  for  each  mental  state  there  is  a 
corresponding  special  condition  of  certain  cellular  groups  of 
the  thinking  organ.  There  is  between  the  intellectual  work 
and  the  ensuing  fatigue  a  close  relation  as  evident  as  that  which 
exists  in  muscular  exercise.  It  does  not  seem  to  me  presump- 
tuous to  suppose  that  some  day  it  will  be  possible  to  demon- 
strate in  this  domain  the  law  of  conservation  of  energy. 

I  know  very  well  that  this  law  has  not  been  verified  in  an 
absolutely  experimental  way  in  all  branches  of  physics. 

I  know  still  better  that  it  is  not  proved  to  hold  true  in 
biology.  I  will  even  admit,  with  certain  philosophic  spiritual- 
ists, "  that  the  law  of  conservation  of  energy  is  extended  to 
biologic  phenomena  by  a  debatable  induction  "  (Naville).  An 
induction  always  remains  debatable,  because  it  ventures  beyond 
the  limits  of  pure  and  simple  proof.  To  discover  a  law  we 
place  ourselves  in  favorable  experimental  conditions,  we  sim- 
plify the  problem.  When  the  law  is  established  on  a  certain 
number  of  definite  facts  we  extend  it  by  induction  to  more 
complex  phenomena,  we  generalize  it.  There  is  in  such  a 
mental  proceeding  occasion  for  error  and  a  possibility  of  hasty 


40  PSYCHIC   TREATMENT 

conclusions.  That  is  why  I  do  not  allow  my  point  of  view  to 
be  obscured  by  this  qualification  of  being  debatable  which 
Mr.  Ernest  Naville  uses. 

But,  logically,  it  seems  to  me  that  it  would  be  still  more 
debatable  to  say  that  this  law  is  not  true  in  the  domain  of 
biology.  Any  precise  fact  does  not  authorize  us  to  make  any 
such  conclusion,  and  to  admit  an  exception  to  a  law  that  is 
everywhere  recognized  where  experimental  conditions  have 
been  favorable.  One  can  not  affirm  a  contrary  idea  simply  by 
showing  that  a  truth  has  not  yet  been  scientifically  established. 
The  question  remains  open  so  long  as  a  demonstration  is  not 
accomplished ;  the  provisory  solution  depends  upon  the  mental 
make-up  of  the  thinker. 

As  all  psychical  action  is  necessarily  connected  with  con- 
comitant cerebral  action  and  with  minute  modifications  of  cel- 
lular chemistry,  it  follows  that  there  can  be  no  pathology  per- 
taining to  mental  and  nervous  affections  without  a  material 
substratum.  If,  upon  autopsy,  the  brain  of  a  melancholiac,  a 
hypochondriac,  or  a  neurasthenic  patient  shows  in  serial  sec- 
tions no  morphological  lesion,  we  must  attribute  the  fact 
largely  to  the  insufficiency  of  our  means  of  investigation.  It 
must  not  be  forgotten  that  certain  slight  alterations  can  never 
be  proved  after  death.  If  the  head  were  transparent,  and  if 
we  could  follow  with  the  eye  all  the  structural  modifications 
which  the  cells  undergo  during  the  process  of  cerebration,  we 
should  detect  the  physiological  action  which,  in  the  opinion  of 
everybody,  accompanies  and,  according  to  our  hypothesis,  pro- 
duces thought. 

When,  in  the  condition  which  we  still  describe  as  normal, 
our  ability  to  work  decreases,  when  our  emotions  become  more 
sensitive,  when  we  are  conscious  of  a  feeling  of  sadness, 
whether  or  not  it  be  justified  by  events,  it  is  because  some  sort 
of  change  has  taken  place  in  our  neurons.  We  are  at  such 
a  time  already  in  an  ailing  condition  if  we  compare  it  with  the 
ideal  state  of  health  and  with  the  well-being  of  an  organism 
that  works  harmoniously  in  all  its  parts. 

I  admit,  then,  without  being  able  to  detect  the  mechanism 
of  the  transformation,  that  what  we  call  thought  is  only  the 


OF  NERVOUS    DISORDERS  41 

product  of  cerebral  activity.  I  conclude  that  no  disturbance 
of  this  thought  can  exist  without  some  pathological  change, 
either  slight  or  lasting,  in  the  brain  substance.  The  expression 
"  disease  without  physical  foundation  " — morbi  sine  materia — 
has  no  reason  for  existence. 

Why  should  one,  in  lessons  devoted  to  therapeutics,  ap- 
proach these  difficult  problems  which  it  is  impossible  to  solve? 
Be  content  with  curing  your  patients  as  best  you  can,  and  leave 
the  mists  of  metaphysics  to  philosophers!  That  is  what  our 
confreres  will  be  apt  to  think. 

I  am  not  of  their  opinion. 

In  the  exercise  of  the  art  of  healing  the  moral  influence 
plays  a  very  important  role. 

The  physician,  even  when  he  has  the  hopeless  naivete  to 
believe  in  the  virtues  of  all  the  drugs  in  the  pharmacopoeia, 
nevertheless  practises  psychotherapy  every  day.  There  are 
some  practitioners  who  do  it  quite  as  unconsciously  as  M. 
Jourdain  used  to  make  prose.  There  are  fewer,  alas!  who 
resolutely  do  it,  and  always  exercise  a  moral  control  over  their 
patients.  Would  it  not  be  useful  to  analyze  this  moral  action, 
to  learn  thoroughly  the  nature  of  the  tool  that  one  uses ;  and 
could  one  make  such  a  study,  and  neglect  the  problems  which 
we  have  just  touched  upon? 

If,  by  reason  of  the  special  circumstances  of  his  position 
or  from  personal  choice,  the  physician  finds  himself  in  frequent 
contact  with  patients  suffering  from  nervous  diseases,  it  is  im- 
possible for  him  to  avoid  these  subjects;  he  must,  cost  what  it 
may,  come  to  some  conclusion  upon  the  matter. 

Without  doubt  these  general  opinions  may  vary  greatly  with 
one  thinker  and  another.  We  would  not  want  to  fit  all  heads 
to  one  cap.  But  I  can  not  imagine  a  physician  so  narrow  as 
to  be  able  to  take  care  of  his  patients  and  yet  voluntarily  push 
all  these  troublesome  questions  to  one  side. 

The  patients,  however,  will  not  allow  a  physician  to  persist 
in  a  prudent  reserve.  Often  with  the  first  words  of  a  consul- 
tation they  draw  you  on  to  philosophic  ground. 

Yesterday  it  was  a  neurasthenic  patient  who  told  you  all 
his  discouragements,  his  weaknesses,  and  his  phobias,  and 


42  PSYCHIC   TREATMENT 

asked  you  pointblank :  "  Is  it  physical  or  is  it  psychical  ?  " 
To-day  it  is  a  mother  who  brings  her  little  girl.  The  poor 
child  is  not  very  bright;  she  has  some  trouble  in  doing  her 
necessary  amount  of  school  work;  she  is  headstrong,  wilful, 
capricious,  and  when  she  is  vexed  she  strikes  her  parents.  "  I 
do  not  know  what  to  think  about  it,"  says  the  mother ;  "  I  can 
not  make  up  my  mind  whether  it  is  naughtiness  or  sickness." 
"As  you  like,  madam,"  you  could  reply,  for  it  is  six  of  one  and 
half  a  dozen  of  the  other.  It  is  certainly  something  that  ought 
not  to  be  there,  and  it  should  be  corrected. 

It  is  in  vain  that  you  resolve  to  be  a  physician  for  the  body 
only.  Willy-nilly  you  are  forced,  if  not  to  reply,  at  least  to 
think.  Oh !  you  can  keep  your  opinion  to  yourself ;  you  are  not 
compelled  to  reply  to  these  indiscreet  questions  by  unbosoming 
yourself  of  all  your  religious  and  philosophic  convictions! 
Very  often  you  would  do  better  to  hold  your  tongue.  You 
will  find  with  a  great  many  persons  a  certain  inability  to  un- 
derstand you,  and  you  ought  to  avoid  thoughtlessly  upsetting 
the  convictions  of  your  questioner.  Very  often  you  may,  as 
the  sincere  diplomat  which  you  ought  to  be,  tell  your  patients 
what  you  think  will  be  expedient  under  the  circumstances. 

You  have  before  you,  we  will  suppose,  a  somewhat  tyran- 
nical father  who  brings  his  daughter  to  you  with  the  air  of 
dragging  her  to  the  seat  of  justice,  and  tells  you  in  detail  all 
the  young  girl's  peculiarities.  He  declares  himself  ready  to  re- 
double his  severity  if  it  is  necessary  to  subdue  her.  Hasten, 
then,  to  make  him  understand  that  it  is  a  diseased  condition 
and  not  a  simple  fault  which  causes  his  daughter's  strange 
conduct. 

You  may  think  what  you  like  in  your  inner  tribunal  con- 
cerning this  specious  distinction,  but  the  advice  is  opportune. 
It  is  by  no  means  a  lie ;  it  is  the  only  thing  possible  when  you 
are  face  to  face  with  that  kind  of  person,  the  only  thing  which 
will  penetrate  his  understanding  deeply  enough  to  modify  his 
state  of  mind,  and  often  you  will  see  immediate  proof  of  the 
happy  effects  of  your  intervention. 

If  the  father  is  not  a  little  queer  himself,  or  even  if  he  should 
be  also  somewhat  unbalanced,  he  is  going  to  be  more  gentle 


OF  NERVOUS   DISORDERS  43 

hereafter,  and  a  little  more  kind  and  indulgent ;  sick  people  are 
excused,  while  those  that  are  in  fault  are  reprimanded.  The 
young  girl,  in  spite  of  her  evident  mental  defects,  feels  the  con- 
tagion of  the  gentleness  and  kindness.  By  these  simple  words, 
"  This  is  a  sickness,"  with  which  you  concluded  your  necessary 
advice,  you  have  poured  oil  upon  the  water,  and  have  done 
more  for  the  health  of  your  patient  than  in  prescribing  for  her 
douches  and  bromides. 

On  another  day  you  will  meet  a  grown-up  young  man  who 
is  a  little  bit  effeminate  in  his  bearing,  and  who  declares  that 
he  is  neurasthenic.  He  can  not  do  any  work  because  he  is 
too  weak ;  he  can  not  bear  to  be  contradicted ;  and  his  mother 
and  his  sister,  who  are  timorously  present  at  the  consultation, 
have  to  do  their  utmost  in  order  not  to  make  him  worse. 

If  you  try  to  show  him  that  up  to  a  certain  point  he  can 
repress  this  irritability,  he  wrill  look  at  you  with  astonishment 
and  retreat  behind  the  fact  that  he  is  neurasthenic.  He  will 
say  it  in  the  same  tone  in  which  he  would  say,  "  I  am  phthis- 
ical, or  diabetic." 

Do  not  hesitate  to  come  back  to  the  charge  and  to  attack 
this  preconceived  opinion.  Show  him  that  this  exaggerated 
irritability,  even  tho  it  may  partake  of  the  nature  of  disease,  is 
not  uncontrollable,  that  it  pertains  only  to  a  physical  disorder 
upon  which  he  can  exercise  a  decided  influence  by  the  educa- 
tion of  his  reason. 

Do  not  tell  him  this  baldly  in  a  few  disdainful  words,  and 
with  the  air  of  absolutely  denying  the  element  of  disease  in  his 
condition;  do  not  accuse  him  of  having  a  character  that  is 
hard  to  get  along  with  and  of  having  no  energy.  You  would 
hurt  his  feelings,  and  would  immediately  cut  short  any  oppor- 
tunity for  treatment. 

Be  content  to  consider  him  as  a  patient,  a  neurasthenic,  as 
long  as  he  places  himself  in  this  category ;  show  him  true  sym- 
pathy, make  him  your  friend,  and  show  him,  by  well-chosen 
examples  from  your  experience  as  a  man  of  medicine,  how 
much  worth  there  is  in  moral  courage  and  a  continual  striving 
toward  the  perfection  of  our  moral  personality. 

The  psychotherapeutic  ideas  that  one  gives  to  a  patient  may 


44  PSYCHIC   TREATMENT 

vary  greatly,  according  to  circumstances  and  according  to  the 
end  that  one  has  in  view.  They  should  vary  according  to  the 
mentality  of  the  subjects  and  the  circumstances.  The  idea  as 
addressed  to  the  patient  may  be  diametrically  opposed  to  that 
which  is  offered  to  his  relatives.  On  the  one  hand,  it  calls  the 
patient's  attention  to  the  efficacy  of  moral  effort  as  if  he  were 
not  sick,  while  on  the  other  hand,  by  laying  stress  on  the  path- 
ological nature  of  such  and  such  a  mental  peculiarity,  it  makes 
the  parents  a  little  more  kindly  indulgent.  Harmony  is  quickly 
established  between  two  persons  who  are  thus  brought  into  re- 
lationship with  each  other. 

I  will  return  to  this  necessity  of  not  confining  one's  thera- 
peutic effort  to  the  patients  alone,  but  extending  it  to  those  who 
live  with  them.  This  is  often  the  only  way  to  obtain  complete 
and  lasting  results. 

I  know  that  in  order  to  practise  this  beneficent  psychother- 
apy it  is  not  necessary  to  have  cut-and-dried  opinions  on  philo- 
sophical subjects.  A  little  tact  and  kindness  is  enough. 

I  have  seen  Catholic  priests  repeat  under  another  form 
what,  in  the  course  of  treatment,  I  have  often  told  my  patients, 
and  so  help  me  more  in  my  work  than  many  of  my  confreres 
would  have  been  able  to  do.  I  meet  pastors  at  the  bedsides  of 
patients,  and  there  we  find  ourselves  on  common  ground,  de- 
spite the  difference  in  points  of  departure. 

It  is  not  at  all  necessary,  however,  in  order  to  enter  their 
brotherhood,  to  put  on  a  white  tie  and  make  a  profession  of 
faith.  But  by  coming  in  daily  contact  with  these  patients 
whose  moral  nature  is  affected,  and  being  continually  occupied 
with  treating  them  in  psychic  ways,  I  have  been  able  to  analyze 
the  ideas  which  have  directed  me  thus  far;  I  have  often  dis- 
cussed these  questions  with  my  confreres  and  with  educated 
patients  who  were  interested  in  these  problems. 

I  can  not,  however,  quite  bring  myself  to  make  a  simple  ex- 
position of  my  method;  for  I  ought  first  to  state  upon  what 
philosophic  basis  I  rest,  and  to  point  out  the  red  thread,  the 
trace  of  which  one  can  follow  through  the  whole  tissue  of  my 
therapeutic  endeavors. 

I  have  said,  and  I  repeat,  that  I  have  no  intention  of  mon- 


OF  NERVOUS   DISORDERS  45 

opolizing  the  truth  for  myself,  and  that  I  can  conceive  that 
one  might  start  from  another  point  of  view.  I  am  content  to 
think  with  the  head  that  Nature  put  upon  my  shoulders;  it 
works  in  its  own  way. 

In  practical  conclusions  I  am  often  met  by  minds  absolutely 
different  from  mine,  such  as  believers  in  the  orthodox  faith ; 
we  have  nothing  in  common  but  the  same  kindly  interest  in  the 
patients,  the  same  desire  to  bring  them  health  by  the  methods 
of  psychotherapy.  We  have  met  each  other  at  a  certain  height, 
like  two  captive  balloons  that  have  drifted  together  and  are 
pursuing  the  same  course.  Follow  their  cables,  and  you  will 
see  that  they  are  attached  at  points  that  are  diametrically 
opposed. 

The  physician  who  reflects  at  all  will  continually  find  in 
his  path  the  problems  of  liberty,  of  will,  and  of  responsibility. 

If  the  care  of  making  visit  after  visit  and  of  prescribing 
medicines  is  sufficient  to  fill  his  life,  the  doctor  can  avoid  these 
troublesome  reflections. 

I  should  like  to  hope  that  the  majority  of  my  brethren 
would  feel  the  need  of  going  further  in  analysis.  Naturally 
all  will  not  take  the  same  road,  and  will  not  arrive  at  the  same 
conclusions.  Many  will  stop  on  the  way,  wavering  between 
reason  and  sentiment ;  but  all,  it  seems  to  me,  ought  to  be  inter- 
ested in  these  subjects,  and  I  should  be  very  much  astonished 
if  their  reflections  did  not  have  some  influence  on  their 
therapeutics. 

I  shall  be  pardoned,  I  hope,  the  digressions  which  follow. 
In  my  eyes  they  are  of  great  importance  in  the  practise  of 
medicine,  as  much  in  the  simplest  therapeutic  applications  as 
in  the  solution  of  medico-legal  problems.  In  short,  it  is  not 
only  in  the  examination  of  criminal  questions  that  the  physi- 
cian sees  these  difficulties  crop  out,  and  feels  all  the  practical 
importance  that  attaches  to  his  solution  of  them. 

There  exists  between  neurotic  patients  of  every  stamp  and 
delinquents  and  criminals  more  connection  than  one  would 
think.  The  neurotics,  like  the  delinquents,  are  antisocial. 
Plato  excluded  the  hypochondriacs  from  his  republic. 

One  might,  it  is  true,  say  that  all  sick  people  are  antisocial. 


46  PSYCHIC  TREATMENT 

All  are  prevented  from  accomplishing  their  work,  and  they 
hinder  the  activity  of  others.  But  the  sick  people  who  die, 
those  who  are  cured,  even  those  who  remain  incurable,  are 
the  dead,  the  wounded,  and  the  invalided  in  the  battle  of  life. 
We  bury  the  former,  we  nurse  the  others,  and  respect  and 
honor  them. 

The  delinquents  are,  in  our  eyes,  the  unworthy  soldiers  who 
must  be  punished  with  discipline,  even  shot  down.  Neurotic 
people  are  stragglers  from  the  army.  We  are  a  little  less  se- 
vere with  them.  They  show  more  or  less  their  inability  to 
march ;  they  are  lame,  that  is  plain.  But  we  do  not  like  them 
much ;  we  are  ready  to  throw  in  their  faces  reproaches  of  lazi- 
ness, of  simulation,  or  lack  of  energy.  We  do  not  know 
whether  to  believe  in  their  hurts  and  put  them  in  the  infirmary, 
or  to  handle  them  roughly  and  send  them  back  to  the  ranks. 

We  are  already  involved  in  a  problem  of  liberty  and  of  re- 
sponsibility, and  it  is  the  absence  of  a  clear  solution  which 
makes  us  hesitate  which  course  to  follow. 

The  question  comes  up  still  more  imperatively  in  the  fre- 
quent cases  where  degenerates  and  unbalanced  persons  find 
themselves  in  conflict  with  justice.  The  abnormal  state  of  their 
minds  and  their  impulsiveness  drives  them  to  culpable  acts, 
to  offenses  against  modesty,  to  violence,  and  even  to  murder. 

Then  the  problem  of  liberty  is  forced  upon  the  physician 
not  only  as  a  simple  question  theoretically  interesting,  but  dra- 
matic and  moving,  because  on  his  evidence  may  depend  the 
future  of  one  of  his  fellow  beings.  You  will  see,  then,  that 
in  touching  these  philosophic  questions  I  do  not  stray  on 
ground  which  does  not  belong  to  us ;  I  remain  on  that  of  prac- 
tical medicine,  facing  the  duties  which  it  imposes  upon  us.  I 
hold  that  every  physician  who  has  understood  his  task  ought 
to  be  interested  in  these  subjects  and  try  to  arrive  at  some 
solution.  This  solution  will  vary,  I  know,  according  to  the 
mentality  and  parts  of  the  thinker,  but  it  is  permissible  to  hope 
for  the  triumph  of  just  views  founded  on  biology  and  natural 
philosophy. 


OF  NERVOUS   DISORDERS  47 


CHAPTER   IV 

The  Problem  of  Liberty — Determinism  —  Flournoy  ;  Ernest  Naville  — 
Imperious  Character  of  the  Motives  that  Induce  Action  —  Popular 
Conception  and  Philosophic  Conception  of  Liberty  —  Our  Slavery 
in  the  Presence  of  Our  Innate  and  Acquired  Mentality  —  Moral 
Orthopedia — Uselessness  of  the  Concept:  Will 

THERE  are  some  conclusions  which  we  easily  arrive  at  by 
using  the  most  elementary  logic,  and  which  we  dare  not  ex- 
press. They  seem  to  be  in  such  flagrant  contradiction  to  public 
opinion  that  we  fear  we  should  be  stoned,  morally  speaking, 
and  we  prudently  keep  our  light  under  a  bushel.  The  problem 
of  liberty  is  one  of  those  noli  me  tangere  questions. 

If  you  submit  it  to  a  single  individual  in  a  theoretical  dis- 
cussion, in  the  absence  of  all  elementary  passion,  he  will  have 
no  difficulty  in  following  your  syllogisms ;  he  will  himself  fur- 
nish you  with  arguments  in  favor  of  determinism.  But  address 
yourself  to  the  masses,  or  to  the  individual  when  he  is  under 
the  sway  of  emotion  caused  by  a  revolting  crime,  and  you  will 
call  forth  clamors  of  indignation, — you  will  be  put  under  the 
ban  of  public  opinion. 

Nevertheless,  it  involves  an  important  problem,  on  the  solu- 
tion of  which  depends  our  attitude  toward  our  fellow  human 
beings  in  the  burning  questions  of  the  education  of  ourselves 
and  others,  in  those  concerning  the  repression  of  misdemeanors 
and  crimes. 

My  convictions  on  this  subject  have  been  of  such  help  to  me 
in  the  practise  of  psychotherapy  that  I  can  not  pass  this  ques- 
tion by  in  silence.  When  there  is  established  between  the  body 
and  the  mind  a  connection  of  causality,  or  when  the  ultrapru- 
dent  biologist  confines  himself  to  stating  the  constant  parallel- 
ism between  psychic  phenomena  and  brain-work,  one  is  forced 
to  accept  determinism. 

This  has  been  very  explicitly  recognized  by  a  philosophic 


48  PSYCHIC  TREATMENT 

physician,  Professor  Flournoy.1  This  is  what  he  says  on  the 
subject  of  liberty : 

"  It  seems  to  me  a  desperate  undertaking  to  attempt  to  pre- 
serve liberty  in  the  face  of  a  principle  that  is  as  definite  as  that 
of  concomitance,  and  that  is  what  it  amounts  to  if  experimental 
psychology  is  the  expression  of  the  truth  in  itself. 

"  For  here  we  have  something  still  more  evasive.  It  is  of 
no  use  to  speculate  upon  the  nexus  that  unites  the  soul  and  the 
body ;  whatever  may  be  the  nature  of  this  bond,  from  the  mo- 
ment that  there  is  a  regular  concomitance,  the  succession  of 
conscious  states  from  the  cradle  to  the  tomb  is  necessarily  also 
regulated,  and  as  inevitable  in  each  of  its  terms  as  the  corre- 
sponding series  of  mechanical  events. 

"  Besides,  if  liberty  were  saved  from  this  predicament  noth- 
ing would  be  gained,  for  it  is  not  only  the  psychophysical  par- 
allelism which  makes  the  obstacle,  it  is  in  a  much  more  general 
way  the  spirit  of  all  our  sciences.  What,  in  short,  does  it  mean 
to  know  an  event  and  to  make  it  a  subject  of  science  if  not  to 
associate  it  with  its  causes — that  is,  to  assign  to  it,  as  such,  the 
series  and  general  collection  of  previous  events  which  have  pro- 
duced it,  and  which  have  made  it  necessary?  To  explain  a 
fact  is  always  to  place  it  among  others  where  it  implicitly  be- 
longs, and  in  virtue  of  which  it  could  neither  not  exist  nor  be 
otherwise.  The  fundamental  axiom  of  all  science  is  that  of  ab- 
solute determinism.  Science  ends  where  liberty  begins." 

But  in  philosophy,  which  has  preserved,  under  the  influence 
of  its  environment,  the  impress  of  religious  spiritualism,  Dr. 
Flournoy  states  with  sorrow  the  apparent  divorce  of  science 
and  morality.  He  thinks  he  is  in  a  blind  alley.  "  Science,"  he 
continues,  "  excludes  free  will,  as  it  also  excludes  the  denial  of 
it;  responsibility  calls  it  back  as  an  absolute  condition.  Must 
one  choose  between  these,  and  sacrifice  the  truth  of  the  first  to 
the  reality  of  the  second  ?  This  would  be  a  hard  extremity,  for 
it  would  be  as  difficult  to  give  up  one  as  the  other." 

I  do  not  see  that  it  is  necessary  to  get  into  this  troublesome 
dilemma. 

Whoever  loves  Truth  must   remain  her   faithful   friend. 

1  Mttaphyriqiu  et  psychologie.    Genfcve,  1890. 


OF   NERVOUS    DISORDERS  49 

When  reason,  which  is  our  most  precise  instrument  of  work, 
leads  us  not  only  by  experience  but  by  induction  to  clear  ideas 
we  can  go  ahead  without  fear. 

It  may  be  that  at  first  we  find  ourselves  drawn  toward  con- 
clusions which  seem  false ;  we  may  fear  to  arrive  at  revolution- 
ary ideas  that  would  be  dangerous  to  the  body  social. 

I  think  this  is  not  an  illusion.  There  is  at  the  bottom  of 
each  one  of  us  a  timid  conservatism  which  accepts  progress  re- 
luctantly, and  which  fears  the  consequences  of  new  ideas  before 
knowing  just  what  they  are. 

Believers  of  all  religions  still  voluntarily  avoid  this  rock  of 
dangerous  repute,  so  that  nobody  may  be  lost  upon  it.  They 
consider  human  reason  to  be  a  fallacious  instrument,  and  they 
take  care  not  to  plunge  their  mass  of  dogmas  into  the  dissolvent 
of  free  inquiry.  Their  position  seems  to  me  irrational,  but  it 
at  least  has  the  advantage  of  being  impregnable.  There  are  no 
arguments  with  which  to  attack  any  one  who  says :  "  I  do  not 
reason,  I  believe." 

But  when  one  is  firmly  established  on  scientific  and  philo- 
sophic ground,  one  must  let  the  donkey  of  his  logic  trot  gently 
on.  He  will  carry  us  straight  to  determinism,  no  matter  how 
violently  we  make  him  turn  about. 

This  is  what  M.  Ernest  Naville  seems  to  have  done  in  his 
book  devoted  wholly  to  the  defense  of  free  will.1  Let  us  rap- 
idly analyze  and  criticize  it  in  the  same  brief  way  in  which  its 
principal  arguments  are  condensed  in  the  Preface : 

"  Whatever  man  does  outside  of  movements  that  are  purely 
instinctive  is  the  product  of  his  will.  But  to  conceive  the  will 
as  a  free  power,  the  sole  creator  of  his  actions,  to  admit  the  will 
of  indifference,  is  an  error  that  a  little  closer  study  of  psy- 
chology makes  one  promptly  reject." 

Here  we  already  find  this  human  liberty  compromised.  The 
pedestal  on  which  it  was  placed  shrinks  according  to  the  degree 
in  which  we  analyze  the  problems  of  volition.  But  let  us 
continue : 

"A  volition  of  which  an  act  is  the  result  is  a  fact  which 
has  many  elements  and  which  gives  rise  to  delicate  analysis. 

>  Le  libre  arbiire,  ttude philosophique.    Par  E.  Naville.     Geneva,  1898. 


50  PSYCHIC   TREATMENT 

"  The  power  of  acting  is  always  found  in  the  presence  of  the 
motor  tendencies  of  sensation  and  the  motives  of  intelligence, 
but  the  motives  only  become  sensory  motors,  according  to  the 
degree  in  which  the  stimulus  creates  a  desire.  The  idea  of  an 
action  has  no  influence  unless  there  is  an  attraction  or  a  repul- 
sion accompanying  it.  We  are  then  in  the  presence  of  various 
impulses,  and  more  often  of  opposite  nature." 

Let  us  note  these  premises ;  they  are  at  the  basis  of  the  idea 
of  determinism. 

"  The  argument  of  determinism,"  continues  M.  Naville,  "  is 
that  these  impulses  produce  an  action  in  an  obligatory  and  in- 
evitable way.  The  argument  of  the  partisans  of  free  will  is 
that  when  different  impulses  arise  we  have  the  power  of  choos- 
ing— to  resist  some  and  to  yield  to  others.  Human  liberty  is 
essentially  relative ;  it  is  shown  only  in  the  possibility  of  choice 
between  the  inducements  that  existed  before  the  act  of  volition, 
because  the  will  could  not  create  its  own  object." 

Here  I  must  confess  my  inability  to  understand. 

Who  does  not  see,  in  short,  that  the  act  of  choosing,  of 
resisting  certain  impulses  and  yielding  to  others,  constitutes 
precisely  a  volition  in  the  strictest  sense  of  the  word?  Now, 
according  to  M.  Naville  himself,  a  volition  is  always  deter- 
mined by  the  attraction  or  repulsion  with  which  the  idea  is 
vested.  If  we  choose,  resist,  or  yield,  it  is  apparent  that  we  are 
impelled  to  do  so  either  by  the  motor  tendencies  of  sensation  or 
by  intellectual  motives.  We  always  yield,  then,  to  an  attraction 
or  a  repulsion.  It  is  the  liberty  of  a  piece  of  iron  attracted  by 
a  magnet. 

This  fallacious  argument,  which  consists  in  excluding  from 
the  group  of  volitions  the  acts  of  choosing,  resisting,  and  yield- 
ing, is  the  only  argument  that  the  eminent  Christian  philoso- 
pher brings  up  against  the  deterministic  idea.  Immediately 
afterward  he  abandons  the  domain  of  reason  and  scientific 
analysis,  in  order  to  exploit  his  fears  on  the  subject  of  danger 
to  morality. 

"  In  order  to  appreciate  the  gravity  of  the  question  that  is 
brought  up,  it  is  enough  to  understand  that  without  an  element 
of  liberty  there  is  no  responsibility,  and  that  absolutely  to  deny 


OF  NERVOUS   DISORDERS  51 

responsibility  is  to  undermine  the  foundations  of  all  our  moral 
and  social  ideas ;  it  means  that  we  should  be  willing  to  strike 
out  of  the  dictionary  the  words,  duty,  good  and  bad  morals,  or 
at  least  give  these  words,  if  they  should  be  retained,  a  wholly 
different  meaning  from  that  which  mankind  has  always  given 
them." 

Very  well,  then !  It  must  be  clearly  stated :  words  take  on 
a  very  different  meaning  when  they  are  submitted  to  a  philo- 
sophic analysis  and  when  they  arise  from  scientific  induction. 
In  current  language  words  express  only  very  fragmentary  and 
incomplete  ideas.  They  convey  a  first  impression,  and  are  used 
without  any  idea  of  the  scientific  truth.  We  shall  always  say 
that  the  sun  rises  and  sets,  even  tho  we  know  that  it  is  an  effect 
caused  by  the  rotation  of  the  earth.  We  speak  of  a  balloon 
floating  free  in  space,  wilfully  forgetting  that  it  is  the  obedient 
slave  of  the  laws  controlling  the  density  of  gas. 

As  soon  as  one  admits  the  scientifically  founded  premises  to 
which  M.  Naville  gives  utterance — that  is,  that  a  volition  is 
always  determined  by  the  motor  tendencies  of  sensation  or  by 
intellectual  motives — there  is  no  escape.  There  is  no  reason 
whatever  for  putting  into  a  separate  class  the  verbs  to  choose, 
to  resist,  and  to  yield.  Cost  what  it  may,  we  must  arrive  at  de- 
terminism or  else  resolutely  turn  our  backs  to  reason. 

We  fear  the  argument  of  determinism  which  states  that 
these  impulsions  produce  our  actions  in  an  obligatory  and  fatal- 
istic manner,  and  it  is  the  fatalism  against  which  we  rebel.  We 
look  upon  evil  impulses  as  the  appetite  of  the  human  animal, 
and  turn  away  from  determinism  as  tho  it  implied  a  revolting 
slavery  and  a  suppression  of  morality.  We  forget  that  we 
may  also  be  slaves  to  goodness,  to  beauty,  to  moral  laws,  that 
we  also  yield  to  higher  impulses  of  sensibility,  and  that  the 
motifs  of  intelligence  become  powerful  motor  impulses  in  con- 
sequence of  the  attraction  or  repulsion  that  goes  with  them,  and 
that  they  are  those  which  often  determine  our  volition. 

Whatever  we  do  we  are  always  obeying  some  sentiment  or 
idea.  Analyze  any  particular  action,  either  the  devotion  of  a 
martyr  or  the  most  shocking  crime,  and  you  will  always  find  an 
imperious  motor  impulse  which  has  determined  the  action.  In 


52  PSYCHIC   TREATMENT 

one  case  it  is  native  nobility  of  feeling,  due  to  heredity  and 
strengthened  by  education ;  such  are  the  moral  or  religious  con- 
victions that  have  been  carefully  cherished  in  the  family  or 
social  circle  in  which  the  individual  has  lived.  In  the  other 
they  are  the  overwhelming  impulses  of  brutal  selfishness  and 
low  passions ;  these  are  deep-rooted  perennial  plants  in  the  fer- 
tile soil  of  society.  And  always  we  yield  to  the  impulsion  which 
by  reason  of  our  previous  mentality  has  held  us  in  the  power  of 
its  fascination. 

One  also  forgets  that  the  fatality  which  is  inevitably  con- 
nected with  the  committed  act  does  not  predetermine  any  of  the 
impulsions  which  are  to  follow.  The  culprit  who  has  thus  far 
been  subjected  to  the  bondage  of  evil  may  find  the  narrow  way 
again;  but,  escaping  from  the  control  of  a  low  sensualism,  he 
may  submit  henceforth  to  the  yoke  of  intelligence  and  of  moral 
ideas. 

The  hypothesis  of  determinism  includes  neither  reflection, 
nor  conversion,  nor  moral  development.  Determinism  confines 
itself  to  the  statement  of  the  connecting  series  of  conscious  acts, 
and  explains  them  by  the  continuous  actions  of  the  motor  im- 
pulses of  our  thinking  brain. 

It  seems  to  me  that  one  could  not  be  very  bold  to  retreat 
before  these  conclusions  which  are  based  on  the  statement  of 
facts,  and  that  one  must  be  very  timid  to  see  in  these  ideas  any 
danger  to  morality. 

Why,  since  the  analysis  leads  us  to  the  denial  of  free  will, 
do  we  keep  on  using  the  terms  "  liberty,"  "  will,"  and  even  "  re- 
sponsibility "  ?  Why  does  the  most  convinced  determinist  say 
every  day :  "  I  am  free,"  "  I  wish  "  ?  It  is  because  he  uses 
these  words  in  the  sense  in  which  they  are  used  in  ordinary 
language. 

It  would  be  a  hard  and  vain  task  to  try  to  reform  the  lan- 
guage which  is  the  vivid  and  intimate  expression  of  our  un- 
thinking impressions,  and  to  dull  its  pictures  by  philosophic 
considerations. 

Let  us  use  words  in  their  commonly  accepted  sense  in  talk- 
ing with  our  fellows,  but  in  delicate  analysis  to  which  we  are 
led  by  philosophic  thought  we  may  permit  ourselves  interpre- 


OF   NERVOUS   DISORDERS  53 

tations  which  retain  their  exactness  even  when  they  seem  op- 
posed to  the  old  conceptions. 

In  the  language  of  the  world  at  large,  which  can  not  follow 
all  fluctuations  of  thought,  to  be  free  means  to  be  able  to  do 
•what  one  wishes  to  do.  We  say  that  we  are  free  when  no  ma- 
terial obstacle  nor  organic  trouble  occurs  imperatively  to  op- 
pose our  desires.  Bars  on  the  one  hand  and  sickness  on  the 
other  are  the  only  obstacles  which,  in  the  eyes  of  those  who 
do  not  reflect,  restrain  human  liberty. 

But  submit  your  own  conduct  or  that  of  your  friends  to 
a  less  summary  examination,  and  you  will  acknowledge  with 
sorrow  that  we  are  also  in  bondage  to  our  innate  or  acquired 
mentality.  You,  young  man,  altho  you  are  so  well  endowed, 
have  a  fatal  instability  of  mental  disposition,  you  are  frequently 
bored,  and  ever}'  day  you  perceive  that  you  are  not  so  free  as 
you  would  like  to  call  yourself.  You,  madam,  by  inheritance  or 
atavism,  are,  as  you  have  said,  impressionable.  You  are  so  un- 
able to  control  your  impulses  that  you  have  just  said :  "  They 
are  stronger  than  I."  There  is,  then,  something  stronger  than 
your  will,  and  that  in  yourself ;  and  yet  without  your  being  con- 
trolled by  anybody. 

The  alcoholic  believes  in  his  liberty,  and  will  say  to  you: 
"  I  am  free  to  drink  or  not  to  drink."  The  unfortunate  fellow 
does  not  see  that  he  is  the  slave  of  the  diseased  demands  of  his 
body  which  can  not  endure  abstinence,  that  his  actions  are  gov- 
erned by  dull  impulses  that  are  insufficiently  restrained,  because 
his  moral  ideas  have  lost  their  freshness  and  tone. 

How  many  people  who  make  a  great  show  of  their  will- 
power are  only  what  one  would  call  "  wilful  " ;  that  is  to  say, 
they  are  impulsive,  and  slaves  to  their  senses.  Wittingly  or 
unwittingly,  we  continually  find  obstacles  in  our  way  which  are 
often  insurmountable,  which  prevent  us  from  acting,  altho  our 
liberty,  in  the  common  sense  of  the  word,  seems  complete.  The 
philosophic  defenders  of  free  will  have  already  given  the  word 
"  liberty  "  a  wholly  different  meaning  from  the  one  in  common 
use  in  daily  speech.  They  call  it  "  relative  liberty  "  when  it  ap- 
pears alsolute  to  one  who  does  not  think.  It  is  no  longer  a  free 


54  PSYCHIC   TREATMENT 

power,  an  omnipotent  queen ;  it  belongs  to  a  constitutional  mon- 
archy. Push  the  analysis  further,  and  you  will  see  that  you  are 
also  the  slave  of  your  happy  impulses  and  kindly  feelings,  of 
your  clear  ideas  of  truth,  goodness,  and  beauty,  and  that  you 
can  not  at  will  change  your  governing  ideas.  Like  the  weather- 
vane  on  the  roof,  you  obey  every  wind,  turning  as  often  to  one 
side  as  to  the  other,  but  you  keep  the  direction  of  the  prevailing 
wind  that  blows  for  you  at  the  time  you  make  up  your  mind. 

The  popular  conception  of  liberty  as  autocratic  power  is 
false.  There  is  no  need  of  delicate  analysis  to  establish  its  very 
simple  character.  The  spiritualists  recognize  the  slavery  which 
is  hidden  under  our  apparent  liberty.  They  know  the  power 
of  the  motor  impulses,  but,  held  back  by  a  moral  uneasiness 
which  is  foreign  to  scientific  induction,  they  add  a  word  or  two 
which  eliminates  it,  and  call  human  liberty  a  "  relative  liberty 
which  creates  itself  as  its  own  object." 

According  to  the  degree  in  which  the  study  of  biology 
makes  us  recognize  the  obstacles  that  accumulate  in  our  path 
by  reason  of  our  native  and  acquired  mental  states,  as  well  as 
our  natural  character,  it  also  diminishes  the  area  in  which  our 
liberty  may  be  exercised. 

Determinism  sees  the  constant  slavery  in  which  we  are 
brought  face  to  face  with  motor  impulses.  It  knows  it  to  be 
inevitable  at  the  very  instant  that  the  reaction  takes  place.  It 
believes  it  to  be  fated  as  long  as  contrary  impulsions  do  not 
come  to  change  the  direction  of  the  movement.  It  denies  free 
will  as  an  untenable  philosophic  conception,  absolutely  inacces- 
sible to  human  reason. 

In  the  language  of  the  people,  even,  vre  find  expressions 
which  hint  at  this  bondage  to  the  motor  impulses.  For  ex- 
ample, some  reprehensible  act  is  proposed  to  some  one,  and  at 
first  sight  would  seem  to  be  of  evident  advantage  to  him.  Im- 
mediately a  struggle  begins  in  his  mind.  The  individual  feels 
at  first  drawn  by  the  attractions  which  the  wrong  act  would 
present  to  him.  But  the  association  of  ideas  steps  in;  moral 
conceptions  surge  up  and  become  more  distinct  under  the  influ- 
ence of  his  reflections — perhaps  the  advice  of  other  people ;  the 
situation  becomes  clarified.  The  idea  of  the  act  loses  its  attrac- 


OF  NERVOUS   DISORDERS  55 

tion,  it  even  causes  a  feeling  of  repulsion.  The  cold,  bare  in- 
tellectual fact  gives  birth  to  warm,  moving  conviction,  and  all 
at  once  the  person  bursts  out,  saying :  "  No,  I  can  not  do 
that ! "  He  has  yielded  to  the  strongest  impulse,  and,  in  a  naive 
and  intuitive  expression  of  moral  determinism,  he  says :  "  I 
can  not  do  it,"  and  not:  "  I  will  not  do  it." 

It  is  neither  criminal  nor  vicious  to  desire.  Each  one  of  us 
is  constantly  restrained  by  moral  barriers  which,  having  to  do 
with  psychic  and  mental  states,  nevertheless  suppress  our  free 
will  as  much  as  a  wall  or  a  policeman  would  restrain  our  lib- 
erty. Fatality  is  naturally  associated  with  the  idea  of  deter- 
minism, but  it  is  still  far  from  that  fatality  of  predestination 
which  is  taught  by  religion.  In  all  these  religious  conceptions, 
where  "  the  hairs  of  our  heads  are  numbered,"  I  have  vainly  en- 
deavored to  find  room  for  liberty.  It  seems  to  me  that  this 
time  one  must  not  only  modify  the  sense  of  the  word,  which  is 
always  permissible,  but  one  ought  to  strike  it  bodily  out  of  the 
dictionary. 

At  the  exact  moment  that  a  man  puts  forth  any  volition 
whatever  his  action  is  an  effect.  It  could  not  either  not  be  or 
be  otherwise.  Given  the  sensory  motor  state,  or  the  state  of 
the  intellect  of  the  subject,  it  is  the  product  of  his  real  mentality. 

Ah !  without  doubt  the  act  would  have  been  otherwise  if  the 
personality  of  the  acting  being  had  itself  been  other  than  it  was, 
if  his  mentality  had  not  been  clouded  by  fatigue,  by  sickness,  or 
by  alcoholic  intoxication.  The  culprit  would  have  been  able  to 
avoid  the  fault  that  he  committed  if  he  had  kept  his  moral  in- 
struction in  mind,  if  these  ideas  which  might  have  touched  his 
understanding  had  been  twice  as  attractive.  But  all  these  ifs 
are  useless,  they  come  too  late.  These  efficacious  attractions 
or  repulsions  have  not  existed,  and  the  deed  has  been  fatally  ac- 
complished, with  all  its  unhappy  consequences  to  the  individual, 
his  family,  and  society. 

But  it  is  nowhere  written  that  the  individual  is  going  to  per- 
sist henceforward  in  a  downward  course,  that  he  is  fatally  com- 
mitted to  evil.  But  the  fault  having  been  committed,  it  should 
now  be  the  time  for  some  educative  influence  to  be  brought  to 
bear,  to  bring  together  in  his  soul  all  the  favorable  motor  ten- 


56  PSYCHIC   TREATMENT 

dencies  and  intellectual  incentives,  to  arouse  pity  and  goodness, 
or  found  on  reason  the  sentiment  of  moral  duty. 

I  know  of  no  idea  more  fertile  in  happy  suggestion  than  that 
which  consists  in  taking  people  as  they  are,  and  admitting  at 
the  time  when  one  observes  them  that  they  are  never  otherwise 
than  what  they  can  be. 

This  idea  alone  leads  us  logically  to  true  indulgence,  to  that 
which  forgives,  and,  while  shutting  our  eyes  to  the  past,  looks 
forward  to  the  future.  When  one  has  succeeded  in  fixing  this 
enlightening  idea  in  one's  mind,  one  is  no  more  irritated  by  the 
whims  of  an  hysterical  patient  than  by  the  meanness  of  a  selfish 
person. 

Without  doubt  one  does  not  attain  such  healthy  stoicism 
with  very  great  ease,  for  it  is  not,  we  must  understand,  merely 
the  toleration  of  the  presence  of  evil,  but  a  stoicism  in  the  pres- 
ence of  the  culprit.  We  react,  first  of  all,  under  the  influence 
of  our  sensibility ;  it  is  that  which  determines  the  first  move- 
ment, it  is  that  which  makes  our  blood  boil  and  calls  forth  a 
noble  rage. 

But  one  ought  to  calm  one's  emotion  and  stop  to  reflect. 
This  does  not  mean  that  we  are  to  sink  back  into  indifference, 
but,  with  a  better  knowledge  of  the  mental  mechanism  of  the 
will,  we  can  get  back  to  a  state  of  calmness.  We  see  the 
threads  which  pull  the  human  puppets,  and  we  can  consider  the 
only  possible  plan  of  useful  action — that  of  cutting  off  the  pos- 
sibility of  any  renewal  of  wrong  deeds,  and  of  sheltering  those 
who  might  suffer  from  them,  and  making  the  future  more  cer- 
tain by  the  uplifting  of  the  wrong-doer. 

Without  doubt,  the  will,  regarded  as  a  free  power,  disap- 
pears in  this  conception  of  determinism.  One's  decisions  and 
wishes  are  all  determined  by  irresistible  motor  impulses  at  the 
moment  when  the  reaction  takes  place,  and  I  have  shown  the 
sophistry  by  which  they  have  tried  to  bring  under  this  rule  the 
acts  of  choice,  resistance,  yielding,  and  their  synonyms.  The 
more  I  analyze  my  own  acts  of  will  and  those  of  my  fellows, 
the  more  I  hold  that  the  chief  characteristic  of  the  will  is  effort. 
That  is  why,  in  describing  the  methods  of  struggling  against 
nervousness,  I  have  preferred  the  term  "  education  of  the  rea- 


OF  NERVOUS   DISORDERS  57 

son  "  to  "  education  of  the  will."  When  we  obey  the  simple 
suggestion  of  our  feelings,  when  we  let  ourselves  do  what  we 
want  to  do,  we  do  not  speak  of  will,  altho  our  volitions  are 
concerned.  We  know  very  well  that  we  are  then  slaves  to  our 
tastes  and  appetites,  and  we  charge  up  this  easy-going  morality 
to  our  motor  impulses.  It  is  when  we  make  an  appeal  to  intel- 
lectual motives  or  to  moral  ideas  that  we  like  to  pretend  to  be 
free,  and  we  call  him  a  strong  man  who  bases  his  conduct  on 
his  rational  principles  and  his  moral  or  philosophic  convictions. 
As  a  matter  of  fact,  he  does  not  obey  suggestions  of  right ;  he 
has  a  clear  idea  of  the  way  he  wants  to  go.  He  finds  attrac- 
tions along  certain  roads  where  other  people  see  no  attractions, 
or  he  experiences,  perhaps,  a  sense  of  instinctive  repulsion.  A 
clear  idea  of  our  end  and  aim  is  enough  to  assure  our  march. 
As  Guyau  has  said,  "  Whoever  does  not  act  according  to  what 
he  thinks,  thinks  incompletely." 

The  objection  is  raised  that  we  may  have  a  clear  knowledge 
of  the  excellence  of  a  determination,  but  that  we  have  not  the 
strength  to  follow  it  up.  I  do  not  deny  the  fact,  but  I  will  not 
admit  the  explanation ;  it  is  not  strength  which  fails  us.  If  we 
still  resist,  if  we  walk  with  hesitation,  if  even  we  plunge  in  the 
opposite  direction,  it  is  because  we  are  still  held  by  the  chains 
of  our  sensibility.  We  see  with  the  mind's  eye  what  would  be 
right,  but  the  heart  is  lacking,  there  is  no  passionate,  emotional 
feeling.  Our  ideas  lead  us  only  when  they  have  become  con- 
victions. Then  there  is  no  longer  struggle  or  voluntary  effort ; 
movement  is  started  and  accelerated  just  as  it  is  with  a  body 
submitted  to  the  force  of  gravity. 

As  it  was  very  neatly  put  by  one  of  my  patients,  who,  tho  a 
sincere  believer,  yet  grasped  my  meaning  at  once :  "  The  will 
drops  passively  into  the  beaten  path  which  sentiment  and  reason 
have  worn  for  it." 


58  PSYCHIC  TREATMENT 


CHAPTER   V 

Absolute  Responsibility — Social  and  Moral  Responsibility — Independent 
Morality:  Reason  is  Its  Guide  —  Gradual  Development  of  Moral 
Sentiments  —  Moral  Conscience  —  Community  of  Aspirations  among 
the  Believers  in  Free  Thought  —  Search  for  Happiness:  Depends 
on  Our  Native  or  Acquired  Mentality  —  Faults  of  Character  or 
Disorder  of  the  Mind 

THE  words  "  liberty  "  and  "  will  "  may  be  retained  in  every- 
day speech  with  the  restricted  meaning  which  has  always  been 
given  them.  When  we  can  obey  the  impulses  of  our  sensibility 
and  the  dictates  of  reason,  we  call  ourselves  free,  because,  as 
we  do  not  regard  our  own  motor  impulses  as  anything  foreign 
to  ourselves,  we  have  the  sensation  of  choosing  and  deciding. 
It  is  useless  to  cast  out  these  terms  which  express  so  well  what 
we  mean. 

But  if  we  analyze  things  a  little  more  deeply,  reason  shows 
us  the  utter  bondage  in  which  we  are  placed  in  relation  to  our 
motor  impulses.  We  necessarily  get  to  the  point  where  we 
deny  free  will,  and  the  will,  like  freedom,  disappears. 

It  seems  to  me  that  no  thinkers  need  try  to  avoid  these  syllo- 
gisms, which  contain  nothing  specious  or  artificial.  Instead  of 
reasoning,  they  become  alarmed,  and  cry :  "  But  what  becomes 
of  morality  in  the  hypothesis  of  determinism  ?  It  can  no  longer 
exist!  "  This  is  the  constant  objection  that  is  brought  against 
biologic  determinism,  this  is  the  obstacle  before  which  they 
shrink  back  frightened,  this  is  the  divorce  between  science  and 
morality  which  the  spiritual  and  Christian  philosophers  so  elo- 
quently point  out.  In  short,  they  say,  to  deny  free  will  is  to  do 
away  with  responsibility,  for  that  is  the  basis  of  morality. 

This  must  be  understood.  True  responsibility,  that  which 
will  one  day  bring  us  face  to  face  with  a  Supreme  Being,  the 
all-powerful  judge  of  our  deeds,  is  of  theologic  origin.  In  or- 
der to  admit  it  one  must  have  an  anthropomorphic  conception 


OF  NERVOUS   DISORDERS  59 

of  the  Divinity,  an  act  of  faith ;  and  the  fact  is  that  science  is 
not  leading  us  in  this  direction. 

But  had  I  succeeded  even  in  getting  these  ideas  into  my 
head,  I  should  find  it  revolting  to  see  men  make  themselves 
judges  of  their  fellow  men.  In  this  world  our  relation  is  of 
brother  to  brother,  and  we  are  nowhere  authorized  to  set  our- 
selves up  as  the  instruments  of  Divine  justice.  We  would  have 
to  voluntarily  shut  our  eyes  to  what  goes  on  in  the  world,  even 
in  our  tribunals,  in  order  to  dare  attribute  to  this  human  justice 
the  infallibility  which  it  should  certainly  possess  if  it  were  to 
take  the  place  of  the  all-seeing  justice  of  Providence.  If  we 
have  a  Father  infinitely  just  and  good,  let  Him  search  our 
hearts  and  distribute  according  to  His  pleasure  either  recom- 
pense or  punishment ;  but,  with  such  frailties  as  we  possess,  let 
us  not  have  the  audacity  to  judge  the  wrong-doing  of  others. 

Responsible  in  the  narrow,  absolute  sense  of  the  word  we 
can  never  be,  for  the  moment  that  we  leave  the  right  path  we 
have  only  acted  in  obedience  to  our  present  impulses  and  we  are 
slaves.  Our  conduct  always  betrays  our  actual  mentality,  and 
this  mentality  is  but  the  product  of  our  natural  temperament 
and  our  education.  Our  relatives  and  friends,  and  society  as 
a  whole,  have  largely  contributed  to  create  the  condition  of 
mind  in  which  we  find  ourselves,  and  if  fault  there  be  we  are 
all  responsible. 

Do  we  mean  to  say  that  there  is  no  such  thing  as  right  or 
wrong,  or  good  and  evil  ?  Should  we  stand  and  look  on  in  pas- 
sive fatalism  at  the  blooming  of  all  these  flowers  of  evil  which, 
since  the  beginning  of  the  world,  have  been  spreading  with  the 
fertility  of  tares  ?  By  no  means  ! 

There  is  a  social  responsibility  which  authorizes  society  to 
repress  vice,  or,  what  is  more  to  the  purpose,  to  prevent  it  and 
to  hinder  its  recurrence.  Society  responds  to  the  necessity  of 
personal  defense,  and  the  solidarity  which  unites  us  enjoins  us 
to  contribute  on  our  part  to  the  maintenance  of  the  moral  order. 

There  is  a  moral  responsibility  which  leads  us  not  only  to 
respect  these  laws  and  to  avoid  conflict  with  society,  but  which 
forces  us  to  bow  before  the  ideal  of  a  moral  law  as  far  as  we 
can  recognize  it.  Religious  morality  itself  draws  only  those 


60  PSYCHIC   TREATMENT 

whose  natural  mentality  and  education  have  led  to  submission. 
In  the  moral  domain  we  can  obey  only  those  laws  to  which  we 
give  our  assent. 

Morality  exists  independent  and  free  from  all  theologic  ties. 
Its  code  is  summed  up  in  a  collection  of  altruistic  sentiments 
and  ideas  which  are  common  to  civilized  people.  Whether  it 
be  sentimental  or  rational  in  the  beginning,  this  morality  little 
by  little  becomes  instinctive  and  automatic.  It  constitutes  what 
we  call  "  moral  conscience."  Without  doubt,  religions  have 
contributed  many  stones  to  the  edifice;  they  have  aided,  in  a 
very  great  degree,  in  the  establishment  of  this  moral  founda- 
tion, but  it  would  be  unjust  to  ascribe  to  them  all  the  honor. 
Morality  is  the  work  of  thinkers  of  all  times,  who  have  had  an 
intuition  of  the  True,  the  Beautiful,  and  the  Good,  and  who 
have  sought  to  base  on  reason  the  moral  code  which  ought  to 
serve  us  as  a  guide. 

It  seems  at  first  sight  that  a  morality  with  sanction  and  ob- 
ligation, such  as  is  evident  in  the  religious  idea,  ought  to  make 
itself  felt  more  easily  and  rapidly,  and  exercise  on  the  masses  a 
more  powerful  and  educative  influence. 

For  almost  two  thousand  years  the  experiment  has  been  go- 
ing on,  and  the  result  is  not  encouraging.  Without  doubt,  the 
morality  of  Christ  remains  the  highest  and  purest.  If  one 
separates  it  from  dogma  it  constitutes  the  ideal  of  independent 
morality,  but  it  has  only  had  the  success  to  win  esteem  in  the 
world.  The  Church,  far  from  aiding  to  spread  it,  has  suc- 
ceeded only  in  maintaining  a  pathological  mentality  which  is 
dominated  by  the  natural  tendency  to  superstition  and  fanati- 
cism. One  needs  a  very  strong  gift  of  optimism  to  expect  of 
these  religions  alone  that  moral  influence  that  ought  to  deliver 
us  from  our  weakness  in  well-doing  and  establish  the  reign  of 
justice.  Religious  morality  itself,  I  repeat,  only  makes  its  be- 
neficent influence  felt  when  its  teachings  are  understood,  when 
they  agree  with  our  inner  feelings,  with  our  natural  aspirations, 
and  when  they  obtain  the  assent  of  our  reason.  It  is  always  in 
the  light  of  independent,  sentimental,  and  rational  morality 
that  we  judge  the  moral  dictates  of  religion. 

The  devotee  often  accepts  without  thinking,  in  a  passive 


OF   NERVOUS    DISORDERS  61 

obedience  to  authority,  certain  ritual  practises  and  dogmas 
which  he  does  not  discuss ;  but  at  least  only  by  consenting  to 
forfeit  completely  his  intellectual  perceptions  can  he  admit 
moral  conceptions  opposed  to  his  natural  sentiments  of  good 
and  to  his  ideas  of  reason. 

Morality  is,  before  everything  else,  social,  and  may  be 
summed  up  in  the  precept :  "  Do  not  unto  others  what  you 
would  not  have  them  do  to  you,"  and  its  corollary :  "  Do  unto 
others  whatever  you  would  have  them  do  unto  you."  It  finds 
its  expression  in  what,  at  first  sight,  is  a  less  comprehensible 
sentiment:  "  Love  thy  neighbor  as  thyself." 

Whoever  can  not  grasp  this  moral  law  is  in  a  state  of  intel- 
lectual inferiority.  It  is  accessible  to  all  without  the  need  of 
the  intervention  of  Divine  sanction.  It  is  more  noble,  it  seems 
to  me,  to  obey  a  sentiment  of  goodness  and  beauty,  and  to  yield 
to  the  motives  of  clear-sighted  intelligence,  than  to  let  one's 
conduct  be  influenced  by  the  hope  of  reward  or  the  fear  of 
punishment. 

Without  doubt,  morality  is  not  absolute.  It  could  not  be  so 
except  on  the  hypothesis  of  a  Divine  revelation  of  a  dictated 
moral  code.  Within  certain  limits,  morality  is  always  relative 
and  variable,  following  the  medium  course  of  humanity.  But 
progress  goes  slowly  and  surely ;  it  tends  to  the  unification  of 
moral  ideas,  and  this  growth  toward  perfection  seems  still  more 
intense  to-day,  altho  the  masses  more  than  ever  avoid  the  yoke 
of  the  Church. 

Let  us  acknowledge  that  the  moral  laity  have  succeeded  no 
better  than  the  Church  in  changing  human  mentality.  One 
must  accept  the  situation  as  it  is;  moral  development  is  des- 
perately slow.  Reason,  so  victorious  in  the  domain  of  exact 
sciences,  encounters  many  enemies  when  she  advances  upon  the 
vague  domain  of  philosophy.  She  falls  into  the  snares  spread 
for  her  by  selfishness,  the  passions,  the  senses,  which  are  so 
often  the  opposites  to  the  incentives  of  Reason.  She  has  to 
struggle  with  determination,  with  preconceived  and  unreason- 
able opinions,  born  in  minds  under  the  suggestion  of  education. 

But  if,  in  spite  of  all,  moral  perfection  is  attained,  it  in- 
creases by  the  efforts  of  free  thought,  as  conscious  of  its  weak- 


62  PSYCHIC  TREATMENT 

ness  as  of  its  power.  People  sometimes  smile  disdainfully  in 
speaking  of  the  goddess  Reason.  I  am  willing  to  admit  that 
she  may  be  weak,  but  she  is  the  only  means  in  our  possession  to 
help  us  in  our  search  for  truth.  It  is  absolutely  necessary  for 
us  to  make  use  of  her. 

Moral  perfection  consists  in  bringing  to  an  end  the  antino- 
my that  often  exists  between  the  senses  and  the  reason.  Moral 
laws,  without  being  dictated  from  on  high,  have  their  beauty. 
We  feel  the  influence  of  their  charm  from  the  cradle,  by  the 
example  of  those  around  us.  We  feel  an  instinctive  sensual 
delight  in  this  pleasant  atmosphere.  There  is  no  effort,  no  con- 
straint, there  is  only  a  natural  abandon. 

A  little  later  the  struggle  commences,  the  world  exercises  its 
educative  influence,  which  is  more  often  inauspicious  than 
favorable.  Still  obedient  to  a  natural  or  acquired  sensibility, 
upheld  by  the  example  of  those  we  love,  we  avoid  dangers. 
With  an  already  practised  glance  of  the  eye  we  see  something 
ugly,  and  flee  from  it  to  seek  for  the  light  of  beauty.  Often 
our  sight  is  dimmed,  but  after  these  eclipses  beauty  reappears, 
attractive  and  imperious.  Our  discernment  becomes  keener, 
and  with  always  firmer  steps  we  advance  along  the  road  of 
goodness.  Oh,  I  know  the  task  is  hard!  Whether  man  be 
guided  by  his  own  strength  or  by  the  teachings  of  a  personal 
philosophy,  or  whether  he  lean  on  the  staff  of  religion,  he  does 
not  escape  downfalls  on  this  long  journey.  It  takes  all  our 
lives  to  acquire  the  mastery  over  ourselves. 

Let  us  bear  in  mind  that  this  does  not  imply  a  voluntary 
effort  of  which  we  are  radically  incapable,  but  an  ever  clearer 
vision  of  the  charm  that  is  associated  with  moral  ideas. 

Alas !  the  unfortunates  who  have  no  other  interest  than  the 
pursuit  of  sensual  pleasures  accomplish  no  more  for  philosophy 
than  those  who  prostrate  themselves  in  temples.  They  belong 
to  the  same  class  as  those  whose  prudent  and  selfish  cal- 
culations lead  them  to  regulate  their  lives  in  conformity  to 
a  moral  law.  Such  is  the  materialism  of  modern  customs  as 
seen  in  our  streets,  despite  the  constant  efforts  of  religion  and 
the  parallel  action  of  independent  morality. 

There  is  danger  for  the  determinists.     It  lies  in  these  in- 


OF   NERVOUS    DISORDERS  63 

voluntary  alliances.  Determinist  doctrines,  when  badly  inter- 
preted, easily  find  adherents  among  those  who  are  only  looking 
for  the  material  well-being  and  who  are  glad  to  give  a  certain 
appearance  of  justification  to  their  conduct.  It  would  be  as 
unjust  to  impute  this  result  to  positivist  doctrines  as  to  blame 
the  Church  when  a  bandit  goes  up  the  sacred  stairway  at  Rome 
on  his  knees  in  order  to  commit  a  crime  a  few  minutes  later. 
Tartuffe  ought  to  have  cast  discredit  on  the  false  devotees  only. 
Every  doctrine  is  exposed  to  these  false  adherents.  Does  not 
one  see  sincere,  devoted  Christians,  imbued  with  the  purest 
morality,  and  social  idealists  mingled,  against  their  will,  in  the 
ranks  of  malevolent  revolutionists,  who  deny  all  social  and 
moral  order? 

In  the  same  way,  how  few  sincere  Christians  there  are 
whose  piety  shows  itself  by  a  true  change  of  heart.  In  the 
same  way,  there  are  not  many  freethinkers  who,  without  giv- 
ing up  their  claim  to  reason,  preserve  their  enthusiasm  for  a 
moral  ideal,  and  seek  to  attain  it  by  the  continued  perfecting  of 
their  ego. 

The  obstacle  to  the  development  of  high  ideas  does  not  lie 
in  the  doctrines  born  of  the  study  of  the  natural  sciences  and  of 
reflections  that  are  beyond  the  reach  of  the  masses;  it  lies  in 
the  enormous  dead  weight  which  constitutes  the  non  thinkers, 
the  indifferent.  These  are  the  true  enemies  of  all  morality — re- 
ligious or  lay. 

Analyzing  the  antagonism  which  seems  to  exist  between 
science  and  religion,  De  Candolle  describes  clearly  the  insur- 
mountable opposition  which  there  is  between  the  maxims  of  au- 
thority and  free  scientific  investigation,1  but  he  adds :  "  Neither 
scientists  nor  religious  men  sacrifice  their  opinions  to  material 
interests,  to  politics,  or  to  pleasure.  When  that  occurs  they  go 
out  of  their  class,  and  lose  the  esteem  of  the  public.  Both  are 
interested  in  intellectual  things,  and  have  to,  if  they  want  to 
succeed,  lead  a  regular,  hard-working,  and  even  severe  life 
when  they  come  of  a  poor  family.  They  have,  in  short,  this 


1  Histoire  des  sciences  el  des  savants  depuis  deux  siicles.    Par  Alphonse  de  Candolle. 
Second  edition.    Geneve  et  Bale.    H.  Georg,  1885. 


64  PSYCHIC   TREATMENT 

much  in  common :  the  precious  sentiment  of  working  in  a  pure- 
ly disinterested  way  for  the  good  of  humanity." 

In  spite  of  their  different  points  of  view,  there  is  a  com- 
munion of  soul  between  intellectual  rationalists  and  truly  re- 
ligious people.  They  defend  the  banner  of  the  ideal  against  the 
unconscious  attacks  of  crowds  that  are  more  indifferent  than 
hostile.  Believers  and  sincere  freethinkers  can  practise  the 
same  religion — that  which  consists  in  wanting  to  be  to-day 
better  than  they  were  yesterday. 

A  clear  idea  of  biological  determinism  imposes  on  those  who 
understand  it  a  special  way  of  looking  at  life,  and  of  judging 
their  own  conduct  and  that  of  their  fellows.  Far  from  weaken- 
ing morality,  it  is  the  most  solid  base  of  moral  orthopedia  that 
we  can  apply  to  ourselves  or  to  others. 

Let  us  insist  on  these  views,  which  appear  paradoxical  only 
to  those  who  do  not  reflect. 

Man  has  never  had  and  never  will  have  any  other  object 
than  the  conquest  of  happiness.  The  majority  of  men  seek  it 
in  the  satisfaction  of  their  desires  and  in  their  pleasures.  They 
storm  against  the  obstacles  that  are  continually  getting  in  the 
way  of  their  desires ;  their  happiness  depends,  first  of  all,  upon 
exterior  circumstances,  thus  it  is  merely  relative  and  ephemeral. 
Others,  fewer  in  number,  work  only  with  the  idea  of  a  future 
life.  Many,  in  short,  thinking  that  a  bird  in  the  hand  is  worth 
two  in  the  bush,  take  good  care  not  to  miss  the  good  fortune 
here  while  hoping  for  something  still  better  in  another  world. 

Now,  whoever  will  reflect  and  search  his  own  life  will  soon 
recognize  that  our  happiness  depends  less  upon  the  circum- 
stances in  which  we  live  than  upon  our  inner  state  of  mind — 
that  is  to  say,  upon  our  morality.  Undoubtedly  we  may  be  ex- 
posed to  misfortune  for  which  we  are  not  responsible,  we  may 
be  the  victims  of  natural  catastrophe,  succumb  to  inevitable 
disease,  or  lose  our  dearest  friends,  but  the  intensity  of  these 
sufferings  depends  before  all  upon  the  spirit  in  which  we  accept 
them.  The  greatest  misfortunes  come  to  us  through  our  in- 
numeral  faults  and  our  abnormal  mentality.  We  are  most  often 
the  authors  of  our  own  troubles,  and  when  we  ourselves  are  not 
at  fault  we  must  bear  the  yoke  of  heredity,  we  pay  for  our 


OF  NERVOUS   DISORDERS  65 

ancestors;  we  suffer  thus  for  the  immorality  of  others.  The 
earth  would  soon  be  like  Eden  if  we  were  all  good  and  just, 
and  if  the  moral  law  were  strictly  observed. 

Humanity,  athirst  for  happiness,  ought,  therefore,  to  strive 
for  moral  development.  All  who  are  willing  to  work  for  the 
realization  of  this  end  have  naturally  a  work  of  education  to 
perform. 

This  education  begins  with  life  itself,  and  it  devolves,  first 
of  all,  upon  parents.  In  order  to  direct  it,  they  ought  to  know 
that  the  faults  which  they  detect  in  their  children  depend  on 
their  native  mentality,  and  that  this  last  has  only  one  possible 
origin — heredity  and  atavism;  let  us  add  here  the  influence  of 
the  factors  which  have  acted  upon  the  child  in  fetal  life.  There 
is  nothing  innate  within  us  that  is  not  the  legacy  of  preceding 
generations.  Also  when  you  discover  in  your  children  some 
intellectual  and  moral  blemishes,  do  not  go  too  far  afield  in 
looking  for  the  causes.  Examine  your  own  mentality,  that  of 
your  father  and  of  your  mother,  of  your  grandparents,  and  you 
will  always  find  the  germ  of  fatal  tendencies.  "  The  fruit  does 
not  fall  far  from  the  tree  " — so  a  German  proverb  runs.  That 
is  a  truth  of  La  Palice,  it  seems  to  me ;  nevertheless,  how  many 
there  are  who  have  never  dwelt  on  this  reflection !  The  ma- 
jority of  parents  are  annoyed  when  they  find  faults  in  their 
children,  and  want  to  know  where  they  came  from.  One  would 
really  think  that  a  bold  cuckoo  had  laid  her  egg  in  their  nest. 

No;  your  heir  comes  into  the  world  with  nothing  but 
what  you  have  given  him.  Do  not  reproach  him  with  his  pov- 
erty. You  must  take  him  as  he  is,  with  his  small  capital  of 
natural  morality,  as  you  forgive  him  his  physical  or  intellectual 
debility.  You  may  sometimes  bemoan  the  hard  implacability 
of  the  laws  of  heredity,  but  do  not  throw  the  weight  of  respon- 
sibility upon  the  poor  creature  you  have  brought  into  the  world. 

It  is  futile  to  revolt  and  indulge  in  recriminations  against  a 
situation  that  is  a  fact.  It  is  our  imperative  duty  to  correct 
vicious  tendencies  by  education,  to  waken  moral  feelings,  to 
train  the  Reason  so  that  she  can  learn  to  discriminate  at  a 
glance  the  motives  which  determine  conduct.  Authority,  and 
even  punishment,  may  be  used  at  certain  times  to  modify  the 


66  PSYCHIC   TREATMENT 

mentality,  but  every  one  will  recognize  that  persuasive  influ- 
ence is  infinitely  preferable,  that  it  only  can  create  a  lasting 
vital  morality,  capable  of  outlasting  the  transient  education 
which  the  parent  can  give. 

It  is  the  same  with  men  as  with  plants :  the  budding  branch 
has  its  faults  from  the  beginning;  direct  its  growth,  train  it 
along  the  wall,  and  perhaps  you  will  have  a  tree  that  will  bear 
good  fruit. 

It  would  be  pleasant  to  delude  one's  self  and  believe  in  the 
constant  efficacy  of  such  culture.  Alas !  there  are  many  un- 
skilled gardeners,  and  many  a  slip  whose  natural  deformity 
is  too  great  at  the  start. 

The  deterministic  conception  is  particularly  valuable  in  our 
relations  with  our  fellow  men.  When  we  are  quite  persuaded 
that  people  are  only  what  they  can  be  by  virtue  of  the  mentality 
with  which  they  were  endowed  and  the  education  which  they 
have  received,  we  pardon  them  their  mistakes  and  faults.  Pity 
takes  possession  of  us,  and  it  is  with  a  feeling  akin  to  love  that 
we  try  to  lead  them  back  to  the  right  way.  But  the  work  is 
much  more  difficult  than  in  the  education  of  a  child.  The  sap- 
ling has  grown,  its  branches  are  not  so  flexible,  and  the  garden- 
er's work  is  often  impossible.  We  are  not  always  in  a  favor- 
able position  to  practise  moral  orthopedia  on  our  fellows.  The 
vicious  escape  from  our  influence,  and  often  we  are  obliged  to 
throw  the  helve  after  the  ax. 

When  we  express  to  certain  persons  the  idea  that  an  indi- 
vidual from  the  mental  point  of  view  can  be  only  what  educa- 
tion has  made  him,  we  often  hear  it  said :  "  But  here  are  two 
young  people  brought  up  by  the  same  parents ;  one  is  a  charm- 
ing fellow,  and  the  other  a  hard  case !  " 

I  am  surprised  that  any  one  should  bring  such  superficial 
judgment  to  the  study  of  these  questions. 

It  is  not  certain,  in  the  first  place,  that  these  two  young 
people  with  such  different  conduct  are  so  far  separated  from 
one  another  from  the  point  of  view  of  their  personal  mentality. 
Wait  a  few  years,  and  you  will  admit  that  they  are  more  like 
brothers  than  you  would  have  believed. 


OF   NERVOUS   DISORDERS  67 

In  spite  of  appearances,  their  education  may  have  been  very 
different. 

We  do  not  respond  only  to  official  education,  such  as  that  of 
our  parents,  of  the  school,  and  of  the  priest.  Without  even 
being  able  to  perceive  it,  we  are  constantly  brought  under  the 
sway  of  the  contagion  of  example ;  at  every  moment  some  strik- 
ing event,  a  sight  which  we  should  not  have  seen,  or  a  word  let 
slip  from  some  of  those  around  us,  opens  new  horizons  to  us. 
The  seeds  of  evil  are  scattered  broadcast  in  the  air,  and  it  needs 
only  the  right  moment  of  receptivity  for  the  germ  to  develop. 
Alas !  often  nothing  can  stop  the  growth  of  the  poisonous  plant ; 
it  attains  a  luxurious  vegetation. 

If  we  really  take  a  look  at  ourselves,  as  one  thinker  has  said, 
we  come  back  full  of  horror.  Have  we,  then,  the  right  to  criti- 
cise others  ?  No ;  we  have  only  one  duty,  and  that  is  to  pardon 
and  stretch  out  our  hands  to  those  who  have  fallen. 

The  simplistic  idea  of  absolute  or  relative  human  liberty 
leads  us  to  establish  an  essential  difference  between  a  fault  of 
character  and  a  mental  malady.  This  distinction,  and  I  can 
not  repeat  it  too  often,  is  artificial  and  untenable. 

At  what  degree  do  indecision,  irritability,  impressionability, 
and  emotional  disturbances  become  sicknesses?  Are  sorrow 
and  pessimism  faults  or  illnesses? 

Even  in  bodily  illness,  it  is  often  difficult  to  draw  the  line 
between  the  normal  state  and  that  of  illness.  At  what  height, 
when  one  is  climbing  a  mountain,  is  it  allowable  to  have  palpi- 
tation of  the  heart  or  dyspnea?  Are  you  sick  because  you 
can  not  stand  a  light  meal  which  your  neighbor  has  digested 
without  any  difficulty? 

In  the  mental  domain  it  is  still  more  impossible  to  try  to 
make  this  distinction.  It  only  seems  to  exist  when  one  is  look- 
ing at  the  extremes. 

It  seems  normal  to  us  to  be  sad  when  we  lose  a  dear  friend, 
to  be  discouraged  in  the  presence  of  failure ;  but  we  regard  any- 
body as  diseased  who  commits  suicide  in  order  to  escape  the 
perplexities  to  which  we  are  all  subjected.  We  all  have  our 
periods  of  indecision,  which  often  appear  exaggerated  to  the 
eyes  of  others ;  but  we  send  a  patient  to  a  physician  when  he 


68  PSYCHIC   TREATMENT 

passes  hours  in  agonizing  perplexity  without  being  able  to  de- 
cide whether  he  will  change  his  shirt  to-day  or  to-morrow. 

In  order  to  make  the  distinction,  it  is  sometimes  said :  "A 
fault  is  corrigible  by  the  will  and  by  educative  influence ;  sick- 
ness handicaps  freedom,  and  does  not  respond  to  these  meas- 
ures." This  is  false.  Our  faults  are  often  rebellious  and  even 
incurable.  Do  we  not  often  see  a  person  who  does  not  seem  to 
have  the  faculty  of  acquiring  tact  ?  Can  we  be  taught  this  very 
estimable  virtue  ?  Do  we  often  lose  that  susceptibility,  or  that 
irritability,  which  makes  life  miserable  for  our  neighbors?  Do 
we  not  know  people  who  are  always  behind  time  ?  They  have 
often  been  punished  for  it,  and  have  sworn  that  it  shall  never 
happen  again.  Ah,  well,  it  always  happens  and  always  will 
happen,  because  it  is  a  part  of  their  mental  make-up. 

On  the  contrary,  you  see  disappear  under  the  influence  of 
certain  advice  some  of  the  old  mental  obliquities  which  every- 
body lays  at  the  door  of  the  diseased.  I  mean  certain  phobias, 
various  obsessions  foreign  to  the  mentality  of  the  majority  of 
people.  Mental  sickness,  in  the  sense  which  the  public  gives  to 
it,  often  disappears  more  rapidly  and  more  completely  than 
what  we  call  a  fault. 

One  often  thinks  that  mental  sickness  makes  itself  manifest 
by  a  combination  of  physical  or  mental  symptoms  which  clearly 
denote  the  pathological  condition.  That  is  not  so.  There  are 
hosts  of  psychopathic  conditions  where  the  physical  health  is 
perfectly  sound ;  even  more,  where  the  mind  appears  healthy — 
the  mental  obliquity  is  unique  and  isolated.  The  patient  only 
needs  medical  treatment,  properly  speaking ;  he  has  need  neither 
of  douches  nor  of  medicines.  He  will  recover  his  mental  health 
by  pure  psychotherapy,  by  the  presence  of  reasonable  impulses 
which  will  change  his  abnormal  mentality.  Whether  they  call 
it  fault,  or  character,  or  mental  sickness,  the  deviation  exists. 
The  subject  has  states  of  mind  which  not  only  appear  abnormal 
in  the  face  of  an  ideal  of  moral  beauty,  but  which  trouble  the 
life  of  the  individual  and  prevent  him  from  playing  the  role  in 
human  society  for  which  he  was  cast. 

In  short,  as  a  last  argument,  mental  malady  is  attributed  to 
physical  causes,  to  intoxications,  and  to  a  wholly  material  proc- 


OF   NERVOUS    DISORDERS  69 

ess,  while  one  attributes  a  fault  to  purely  moral  causes.  This 
also  is  false. 

I  have  said,  in  virtue  of  the  psychophysical  parallelism,  the 
abnormal  mentality  assumes  an  abnormal  state  of  the  brain. 
This  may  result  from  physical  and  moral  causes,  capable  of  act- 
ing concurrently  in  a  fault  as  well  as  in  a  mental  disease. 

The  task  of  the  physician  as  that  of  the  educator  is  to  ascer- 
tain the  abnormal  mentality,  to  find  out  its  moral  or  physical 
causes,  applying  to  both  of  them  the  necessary  and  inevitable 
idea  of  determinism,  so  as  to  be  able,  with  the  aid  of  physical 
and  moral  influences,  to  practise  mental  orthopedia.  This  is 
what  educators  have  applied  themselves  to  during  all  time. 
Unfortunately,  physicians  have  not  seen  with  sufficient  clear- 
ness that  they  are  often  called  upon  to  treat  the  morale  of  their 
patients,  to  correct  their  faults,  and  to  give  them  a  more  ra- 
tional mentality.  As  to  the  educators,  they  have  not  enough 
biological  knowledge  and  no  clear  views  on  the  mental  passivity 
of  the  man  who  believes  himself  to  be  free.  Often  they  think 
that  it  is  a  fault  which  they  have  detected,  and  they  imagine 
that  the  checking  of  it  is  only  a  question  of  redoubling  severity. 
Often  they  are  doubtful,  and  ask  themselves  whether  it  is  not  a 
diseased  condition.  Often,  at  a  late  day,  they  recognize  that 
they  have  been  on  the  wrong  track,  and  it  is  not  always  possible 
to  change  the  course. 

Persons  imbued  with  absolute  ideas  of  liberty  and  responsi- 
bility have  a  heavy  hand  in  moral  orthopedia.  They  are  often 
cold  and  severe,  and  even  when,  after  taxing  their  ingenuity  to 
bring  about  some  artificial  good,  they  give  their  advice,  the 
culprit  feels  in  it  all  the  harshness  of  a  reproach. 

In  order  to  change  the  state  of  mind  of  any  one  who  has 
fallen,  it  is  not  sufficient  to  grant  him  extenuating  circumstan- 
ces and  to  show  him  pity ;  one  must  love  him  as  a  brother,  and 
stand  shoulder  to  shoulder  with  him  with  a  profound  sense  of 
our  common  weakness. 


70  PSYCHIC   TREATMENT 


CHAPTER   VI 

Difficulties  of  Moral  Orthopedic* — Criminality — The  Partisans  of  Abso- 
lute Responsibility  and  the  Determinists  Remain  Irreconcilable 
Adversaries  in  Theory — Possible  Compromise  in  Practise — Necessity 
of  this  Understanding — The  Role  of  Human  Justice — Educative  End 
of  Repression — Urgent  Reforms  of  Penal  Laws 

ALREADY  in  the  education  of  children,  in  our  daily  inter- 
course with  our  fellows,  in  the  efforts  which  we  put  forth  to 
correct  vicious  habits  or  to  cure  disease,  the  absence  of  clear 
deterministic  ideas  often  produces  tragic  results. 

There  are  thousands  of  these  children  who  are  intellectually 
and  morally  delinquent,  in  whom  education,  far  from  correct- 
ing the  primitive  deviation,  has  only  accentuated  the  fault,  and 
has  led  to  the  rupture  of  family  ties.  In  families  and  in  society 
nothing  is  so  rare  as  harmony ;  everywhere  the  social  machinery 
grates,  and  when  we  search  for  the  cause  we  only  find  a  little 
fine  sand  in  the  wheels  which  a  whiff  of  indulgence  would  have 
easily  blown  away. 

But  parents  do  not  possess  this  clear  sight  of  things.  Their 
indulgence  is  weakness,  their  firmness  becomes  severity.  The 
task  of  parents  is  doubly  difficult  in  education,  for  not  only  do 
they  bequeath  to  their  children  certain  mental  defects,  but  they 
often  cultivate  their  faults  in  setting  before  them  an  example 
of  the  same  weakness.  This  insufficiency  of  educative  aptitude 
becomes  dangerous  when  one  has  to  deal  with  rebellious  sub- 
jects, and  it  then  seems  necessary  to  give  up  family  education. 

In  the  institutions  intended  for  the  education  of  backward 
children  the  moral  influence  seems  more  efficacious.  It  is  ex- 
ercised by  strangers  of  a  different  mentality  who  are  more  im- 
partial. But  to  return  to  the  family,  the  veneer  which  seemed 
so  firmly  put  on  is  rapidly  loosened ;  the  native  tendencies  reap- 
pear, and  everything  has  to  be  begun  over  again.  It  is  often 
the  same  in  the  case  of  moral  orthopedia,  which  constitutes  the 


OF   NERVOUS    DISORDERS  71 

important  element  in  a  cure  of  nervousness.  At  the  clinic 
everything  goes  well ;  in  the  presence  of  kindly  strangers  the 
mental  peculiarities  are  better,  the  subject  becomes  quiet  and 
patient ;  he  is  under  the  influence  of  the  moral  contagion  of  his 
environment.  Often  this  influence  persists  and  leads  to  a  defi- 
nite change  in  his  mental  point  of  view,  but  in  other  cases  the 
effort  is  in  vain,  and  the  disappointed  parents  find  their  son  or 
their  daughter  just  as  egoistic,  irritable,  or  unmanageable  as 
before. 

Nevertheless,  the  question  is  one  that  concerns  our  children ; 
we  find  in  them  an  inherited  mentality ;  we  are  conscious  of  the 
faults  which  we  have  committed  in  their  education ;  we  recog- 
nize in  them  the  weakness  of  the  mother  and  the  selfish  indif- 
ference of  the  father.  We  know  that  if  the  offspring  was 
deformed  at  its  birth  we  could  not  straighten  it  by  our  art ;  in 
short,  we  have  an  instinctive  indulgence  for  our  own  and  for 
those  that  we  love. 

And  what  becomes  of  this  good  will  when  there  is  no  tie  of 
blood,  when  nothing  binds  us  but  this  vague  and  feeble  human 
fraternity,  when  it  is  a  question  of  delinquents  and  criminals 
whose  acts  arouse  our  indignation. 

Then  we  no  longer  see  the  numerous  physical  and  moral 
causes  which  have  led  to  the  deformity.  Forgetting  our  own 
weakness,  we  set  ourselves  up  as  judges  and  we  punish  accord- 
ing to  the  absurd  law  of  retaliation. 

In  criminal  suits  within  the  august  walls  of  the  court  of 
assizes  we  listen  to  lamentable  discussions  upon  responsibility. 
The  public  accuser  expounds  questions  of  metaphysics  and  de- 
clares that  free  will  exists,  as  if  he  were  discussing  a  legal 
prescription.  Medical  experts  affirm  the  total  or  partial  re- 
sponsibility of  the  delinquent.  But  the  grocers  and  the  wine 
merchants  on  the  jury  know  more  about  these  things ;  they  do 
not  let  themselves  be  led  away  by  philosophic  reflections  of  an 
anthropologist,  and,  without  any  hesitation,  they  send  the  in- 
sane person  to  prison  and  often  to  the  scaffold. 

In  these  questions  of  criminality  the  situation  is  at  bottom 
no  more  tragic  than  is  that  of  education.  The  problem  is  more 
pointed  and  more  dramatic,  but  it  is  less  often  met.  In  the  case 


72  PSYCHIC   TREATMENT 

of  the  incorrigible  criminal  it  is  often  a  matter  of  indifference 
whether  he  spends  the  rest  of  his  days  in  the  asylum  or  in 
prison.  But  human  injustice  becomes  disastrous  when  it  is  a 
question  of  the  numerous  delinquents  whose  mentality  could  be 
modified,  and  when  it  concerns  the  stray  sheep  who,  without 
coming  into  conflict  with  penal  law,  nevertheless  disturbs  the 
peace  of  the  body  social.  And  everywhere  at  the  base  of  these 
false  judgments  we  find  the  sorry  conception  of  absolute  re- 
sponsibility, everywhere  we  are  brought  face  to  face  with  the 
insurmountable  difficulty  of  deciding  where  liberty  begins  and 
where  it  ends,  where  health  stops  and  where  mental  disease 
begins. 

It  is  no  longer  a  question  here  of  philosophic  problems  pure 
and  simple,  of  dreams  over  the  first  causes,  where  each  one  may 
give  full  indulgence  to  the  vagaries  of  imagination.  These  are 
burning  questions  which  confront  us,  and  on  their  immediate 
solution  hangs  the  fate  of  one  of  our  fellows. 

I  do  not  by  any  means  hug  to  myself  the  illusion  that  it  may 
be  possible  to  reach  a  state  of  perfect  agreement  on  these  ques- 
tions. Without  doubt,  right  ideas  are  imperishable,  and,  tho 
their  march  may  be  slow,  they  can  never  be  stopped ;  but  the 
progress  is  too  slow  for  any  one  to  wait  for  the  solution  of  the 
problem.  There  will  always  be  spiritualists  who  will  believe  in 
the  liberty  of  indifference,  in  sovereign  will,  and  in  absolute  re- 
sponsibility ;  they  will  for  a  long  time  preserve  the  mental  point 
of  view  of  the  Old  Testament.  Others  will  consent  to  leave 
their  thoughts  some  liberty,  and  in  a  certain  measure  to  be  in- 
fluenced by  the  contagion  of  determinist  ideas.  They  mingle 
water  with  their  wine,  and,  when  passion  or  the  fear  of  seeing 
their  ideas  of  morality  submerged  does  not  come  in  to  trouble 
their  judgment,  they  recognize  the  influence  of  heredity  and 
of  environment,  and  will  show  an  unequal  contingent  indul- 
gence, often  more  unjust  than  the  strictness  of  an  orthodox 
person.  And,  last,  there  always  has  been  and  there  always  will 
be  a  growing  multitude  of  thinkers  who  can  not  withstand  the 
desire  for  knowledge,  who  have  only  one  end,  the  search  for 
truth,  and  exert  in  its  pursuit  all  the  forces  of  their  being,  their 
affective  sensibility,  and  their  reason. 


OF   NERVOUS   DISORDERS  73 

These  parties  will  always  exist;  they  have  existed  from  all 
time ;  they  will  never  change. 

The  lawmakers  who  prepare  our  penal  code,  ought  they  to 
suspend  their  proceedings  until  peace  is  made,  until  the  world 
may  be  converted  to  determinism  or  brought  under  the  yoke 
of  the  Church  ? 

No,  this  is  not  possible.  We  have  need  of  laws,  of  political 
and  social  institutions,  and  they  are  always  established  on  the 
foundation  of  compromise  and  reciprocal  concessions.  Tho 
we  may  be  adversaries  on  the  ground  of  theory,  we  can,  how- 
ever, clasp  hands  in  practise. 

It  seems  to  me  that  in  order  to  reach  this  end  we  must  first 
of  all  throw  away  the  apple  of  discord,  the  word  "responsi- 
bility "  in  the  absolute  sense  which  has  been  given  to  it. 

Social  responsibility  is  confused  with  the  notion  of  culpa- 
bility. The  first  task  of  human  justice  is  to  prove  the  offense — 
that  is,  the  infraction  of  the  existing  laws. 

Without  feeling  the  burden  of  moral  responsibility,  which 
is  an  affair  of  the  individual  conscience,  or  of  transcendental 
responsibility,  which  is  a  question  of  metaphysics,  Justice  has 
only  one  right  which  is  at  the  same  time  a  duty.  She  ought  to 
do  everything  to  oppose  wrong  acts,  to  stop  their  performance 
if  there  is  still  time ;  she  ought  to  hinder  their  repetition  and  to 
work  to  repair  the  harm  that  has  been  done. 

This  repression,  which  ought  to  be  prompt  in  order  to  be 
efficacious,  authorizes  such  measures  of  rigor  as  arrest,  impris- 
onment, and  punishment.  But  this  justice  is  not  the  goddess 
with  blindfolded  eyes  who  weighs  the  misdemeanor  or  the 
crime,  and  puts  into  the  other  scale  the  weight  that  ought  to 
reestablish  equilibrium. 

The  best  means  of  preventing  the  recurrence  of  a  wrong 
act  is  the  improvement  of  the  culprit,  and  just  as  in  the  family 
the  father  uses  his  educative  influence  for  this  purpose,  society 
ought  likewise  to  make  an  effort  to  bring  some  favorable  influ- 
ences to  bear  upon  the  soul  of  the  delinquent  which  may  im- 
prove his  mentality. 

Punishment,  even  tho  it  be  severe,  may  be  used  for  this 
end ;  it  can  help  to  lead  the  wrong-doer  back  into  the  right  way 


74  PSYCHIC   TREATMENT 

and  be  of  use  as  a  warning  to  those  who  might  be  tempted  to 
imitate  him.  But  we  all  feel  that  brutal  repression,  which  only 
takes  account  of  the  fact  and  closes  its  eyes  to  the  circum- 
stances in  which  it  was  produced,  is  revolting  to  our  moral 
conscience. 

We  accept  punishment  with  just  so  much  less  difficulty  ac- 
cording to  the  degree  in  which  it  is  just,  and  in  which  we 
recognize  in  the  one  who  metes  it  out  to  us  the  desire  to  lead 
us  back  to  the  right  way*  On  the  other  hand,  we  submit  to  it 
in  a  very  bad  spirit  and  with  revolt  in  our  souls  when  it  is  dic- 
tated by  the  spirit  of  vengeance.  Without  doubt,  penal  laws 
must  have  a  certain  precision,  and  must  catalog  the  various 
crimes  and  decide  upon  the  penalties  which  should  go  with 
them.  But  when  it  comes  to  the  application  of  them  there 
ought  to  be  more  attention  paid  to  shades,  to  the  appreciation 
of  motives,  to  the  analysis  of  mental  states,  and  to  the  modifi- 
cation of  the  punishment  within  its  fixed  limits.  This  should 
be  considered  more  and  more  in  proportion  as  we  know  better 
the  physical  or  the  moral  causes  of  the  criminal  deed. 

Whether  one  is  an  out-and-out  determinist  or  whether  one 
reserves  to  human  liberty  more  or  less  power,  one  must,  never- 
theless, recognize  certain  truths.  It  is  evident,  first  of  all,  that 
a  great  many  criminals  bow  to  the  yoke  of  heredity  and  are 
predisposed  to  crime.  The  term  "  born  criminal  "  of  Lombroso 
expresses  this  slavery  too  crudely.  There  are  no  born  crimi- 
nals, but  there  are  individuals  whose  mentality  is  abnormal,  and 
who,  if  propitious  circumstances  present  themselves,  will  grow 
up  with  criminal  tendencies.  If  we  can  constantly  lessen  those 
temptations  which  determine  their  reactions  they  will  remain 
inoffensive  degenerates.  Without  doubt  this  is  not  always  pos- 
sible ;  but  has  society  really  fulfilled  its  duty  in  this  direction  ? 
Does  it  watch  with  sufficient  love  over  the  human  nursery? 
Does  it  work  with  zeal  to  cure  the  sickly  nurslings  and  to  pre- 
serve the  others  from  contagion?  Evidently  not. 

This  wind  of  true  justice  has  not  been  blowing  very  long, 
and  society  ought  to  recognize  more  and  more  that  if  vicious 
people  exist  it  is  because  it  allows  material,  intellectual,  and 
moral  destitution  to  exist  in  the  cases  of  thousands  of  indi- 


OF  NERVOUS   DISORDERS  75 

viduals.  Society  is  still  a  negligent  stepmother  who  has  only 
herself  to  blame  if  her  children  wander  away.  She  ought  to 
recognize  her  fault,  and  if  to  reform  the  transgressor  and  pre- 
vent new  misdeeds,  she  is  obliged  to  be  severe,  she  ought  to  be 
so  with  love,  and  with  education  as  the  only  aim  in  view. 

One  is  aware  of  these  facts  in  every  circle.  From  them  are 
born  the  institutions  for  the  improvement  of  young  delinquents, 
for  the  education  of  unmanageable  children,  the  associations 
for  the  help  of  discharged  criminals.  It  is  the  conception  of 
punishment  as  an  educative  means  which  has  produced  the  fer- 
tile idea  of  conditional  freedom.  A  sentence  is  pronounced 
that  is  appropriate  to  the  misdemeanor  that  has  been  commit- 
ted, but  by  reason  of  the  circumstances  under  which  it  was 
done,  and  of  the  actual  mental  state  of  the  delinquent,  society 
defers  the  punishment,  on  condition  that  no  new  infringement 
makes  it  necessary  to  revoke  the  reprieve. 

We  would  go  still  further,  for  it  is  the  law  of  pardon  which 
we  want  to  introduce  into  our  code.  Just  as  a  father  can  rep- 
rimand his  son,  indicate  to  him  the  punishment  which  he  has 
drawn  upon  himself  and  definitely  postpone  its  application  to 
him,  in  the  feeling  that  the  admonition  will  be  enough,  so 
society  has  the  right  to  pardon.  It  is  evident  that  this  law  is 
a  difficult  one  to  apply.  In  fairness  it  would  seem  as  tho  a 
father  should  not  grant  kindly  pardon  to  one  son  when  on  the 
same  day  he  has  punished  another  for  the  same  fault.  But  the 
difficulties  of  application  ought  not  to  make  us  throw  out  a 
sound  principle  at  the  start. 

Society  ought  always  more  clearly  to  recognize  that  the  one 
and  only  end  of  justice  is  to  prevent  evil,  and  that  it  must  prac- 
tise a  conscientious  and  expeditious  moral  orthopedia. 

The  tribunals  do  not  have  to  settle  the  question  of  free  will 
and  of  true  responsibility.  However,  this  question  is  still  put 
to  us  physicians  to-day  in  criminal  suits.  And  the  physician 
replies  to  it  by  admitting  irresponsibility,  a  relative  responsi- 
bility, or  a  semi-responsibility!  We  take  part  in  these  cele- 
brated suits  in  these  Byzantine  discussions. 

If  I  were  called  as  an  expert  before  the  tribunal  I  would  re- 
fuse to  reply  to  this  inappropriate  question,  or,  rather,  I  would 


76  PSYCHIC   TREATMENT 

reply :  You  ask  me  if  the  individual  is  responsible ;  you  put  a 
question  of  transcendental  philosophy  to  me  which  I  can  not 
decide  in  a  medico-legal  report ;  the  discussion  would  convince 
nobody.  If  you  speak  of  social  responsibility,  that  is  not  for 
me  to  discuss ;  you  have  fixed  it  in  establishing  a  breach  of  the 
laws  and  the  very  existence,  even,  of  the  crime.  As  to  the 
moral  responsibility,  that  concerns  the  delinquent  only.  We 
do  not  have  to  enter  into  this  personal  domain  of  the  conscience. 

You  need  the  information  which  I  possess  in  order  to  ana- 
lyze the  mentality  which  has  determined  the  crime,  to  detect 
the  motives  that  have  influenced  the  guilty  person.  Very  well, 
I  will  try  to  tell  you  if  the  patient  presents  the  symptoms  of  any 
malady  which  could  have  influenced  his  determinations.  I 
could,  perhaps,  tell  you  whether  he  be  an  epileptic,  and  if  the 
deed  were  committed  in  one  of  those  mental  states  that  are 
equivalent  to  a  convulsive  crisis ;  I  could  tell  you  whether  he 
were  alcoholic,  subject  to  delirium,  or  a  general  paralytic;  I 
could  enumerate  for  you  the  mental  and  bodily  stigmata  of  de- 
generacy. All  the  indications  that  my  medical  experience  could 
furnish  you  would  be  at  your  disposal,  not  to  elucidate  the 
hateful  question  of  responsibility,  but  to  establish  the  expe- 
diency of  means  of  repression. 

The  accused  is  plainly  an  epileptic:  he  has  acted  uncon- 
sciously, while  his  personality  was  completely  clouded ;  put  him 
into  a  suitable  asylum  where  he  will  be  cared  for  and  at  the 
same  time  prevented  from  hurting  himself.  This  one  is  an 
alcoholic :  place  him  under  special  psychiatrical  treatment ;  put 
him  in  an  asylum  for  inebriates  or  the  insane.  You  have  to  do 
with  a  dangerous  and  incorrigible  criminal,  a  perfect  wild 
beast:  keep  him  in  prison.  If  he  is  a  chance  criminal,  try  to 
find  out  carefully  the  motives  which  led  him  to  do  the  deed ; 
take  into  account  the  influences  which  have  affected  him,  not,  I 
repeat,  for  the  sake  of  fixing  his  responsibility  (hateful  word), 
but  in  order  to  be  able  to  lay  one's  hands  on  the  most  appro- 
priate measures  to  change  the  mentality  of  the  subject,  and 
to  suppress  even  the  source  of  the  crime.  In  one  case  you  will 
see  that  the  culprit  will  accept,  without  any  aggravation  of  his 
moral  deterioration,  the  punishment  which  by  law  and  in  his 


OF   NERVOUS    DISORDERS  77 

own  mind  is  considered  appropriate  to  the  misdeed.  When  he 
is  freed  he  will  remember  the  punishment  which  was  imposed 
upon  him,  and,  perhaps,  will  later  bless  the  hand  which  has 
chastened  him.  For  another  you  would,  perhaps,  dread  the 
demoralizing  effect  of  prison  life  and  of  the  promiscuous  ming- 
ling with  criminals  of  more  vicious  tendencies,  and  you  would 
lighten  the  punishment.  And  in  certain  cases,  which  are  al- 
ways more  numerous,  you  will  grant  the  delinquent  the  benefit 
of  conditional  freedom  or  of  pardon. 

Are  these  views  very  revolutionary?  I  do  not  think  so;  it 
seems  to  me  that  Christians  ought  first  of  all  to  remember  the 
words  of  their  Leader  concerning  the  woman  taken  in  adultery : 
"  He  that  is  without  sin  among  you,  let  him  first  cast  a 
stone  at  her !  " 

It  is  the  fashion  nowadays  to  decorate  public  buildings  with 
allegorical  frescos.  Could  we  not  reproduce  this  touching 
scene  in  our  sumptuous  palaces  of  justice?  But,  perhaps,  the 
sight  of  it  would  suggest  troublesome  reflections  to  those  pres- 
ent. But  we  won't  dwell  upon  this  point. 

The  jurists  in  general  are  opposed  to  these  ideas.  They 
have  an  instinctive  horror  of  criminal  anthropology,  and,  like 
all  of  us,  they  are  the  slaves  of  eternal  routine,  and  of  intel- 
lectual sloth.  Thus  the  aspect  of  our  tribunals  undergoes  very 
little  change. 

The  prosecuting  attorney,  exaggerating  his  role  of  public 
accuser,  tries  to  blacken  the  accused,  in  order  to  set  forth  the 
horror  of  the  crime,  and  its  cunning  premeditation;  he  insists 
upon  the  necessity  of  making  an  example,  he  entreats  the  jury 
not  to  allow  themselves  to  be  swayed  by  considerations  of  pity. 

The  attorney  for  the  defense,  in  his  turn,  works  himself  up 
into  a  fury,  and  does  all  he  can  to  whitewash  his  client.  He 
denies  the  facts  because  the  adversary  did  not  bring  absolute 
proof  of  them ;  he  profits  cleverly  by  technical  slips,  he  imagines 
various  expedients  and  takes  advantage  of  personal  peculiari- 
ties of  the  Court,  and  at  last,  in  a  moving  voice,  he  appeals  to 
the  clemency  and  calls  forth  the  tears  of  his  audience.  Under 
the  influence  of  these  contrary  suggestions  the  judges  or  the 
jury  waver.  If  the  orator  is  not  eloquent,  they  keep  their 


78  PSYCHIC  TREATMENT 

opinion;  they  had  settled  it  before  he  spoke.  But  words  are 
powerful,  and  often  the  victory  is  to  him  who  best  knows  how 
to  arouse  the  sensibility,  to  stir  up  indignation,  or  to  melt  the 
heart  with  a  warm  breath  of  pity.  Oratorical  suggestion  is  not 
always  founded  upon  rational  persuasion,  it  is  frequently  op- 
posed to  it. 

It  is  by  no  means  a  question  of  suppressing  the  tribunals  or 
of  reorganizing  them  altogether.  But,  impressed  by  the  ne- 
cessity of  combating  crime  by  truly  efficacious  measures,  above 
all  to  prevent  its  recurrence  by  the  improvement  of  the  guilty, 
judges  and  advocates  ought  to  seek  to  establish  wrong-doing 
upon  facts,  to  study  the  mentality  of  the  delinquent,  and  to 
choose  the  best  means  of  obtaining  this  end. 

There  ought  to  be  established  a  certain  gradation  of  punish- 
ments, but  not  regulated  only  according  to  the  gravity  of  the 
misdemeanor.  The  motor  impulses  should  be  taken  into  ac- 
count, and  the  state  of  mind  of  the  subject  at  the  time  when  the 
deed  took  place.  There  ought  to  be  in  its  application  not  a 
harmful  laxity  of  extenuating  circumstances,  but  a  clear  choice 
of  the  most  useful  punishment,  as  much  from  the  ideal  point 
of  view  of  reforming  the  guilty  one  as  from  the  very  practical 
view  which  consists  in  putting  an  end  to  these  wrong-doings. 

The  tribunal  ought  to  be  a  council  of  wise  men  of  all  social 
classes  chosen  by  the  people.  It  would  be  right  and  natural  to 
give  the  preference  to  jurists,  physicians,  and  religious  or  lay 
teachers,  but  not  to  forget  the  men  of  good  common  sense  who 
are  found  in  all  social  circles,  men  of  experience  who  have  at- 
tracted the  attention  of  their  fellow  citizens  by  the  integrity  and 
uprightness  of  their  public  and  private  life. 

Assured  that  the  accused  will  no  longer  be  the  victim  of 
brutal  repression,  and  that  he  will  no  longer  profit  by  unjust 
indulgence,  the  advocate  and  the  public  accuser  will  have  no 
right  to  declare  themselves  adversaries  from  the  start,  and  to 
struggle  for  the  possession  of  the  delinquent.  They  will  no 
longer  represent  the  attack  or  the  defense  in  its  revolting  bru- 
tality, but  they  will  cooperate  to  elucidate  the  difficult  problem. 
Instead  of  going  into  every  detail,  they  will  find  it  better  to  lay 
the  situation  before  the  judges,  and  will  act  upon  their  deliber- 


OF  NERVOUS   DISORDERS  79 

ations  less  by  their  declamations  than  by  persuasion  which  does 
not,  however,  exclude  eloquence. 

There  is  no  place  in  these  discussions  for  the  word  "  re- 
sponsibility "  in  the  absolute  sense  which  has  been  given  to  it. 

I  have  often  seen  men  of  the  legal  profession  who  recognize 
that  the  tribunal  ought  to  constitute,  as  it  were,  a  family  council 
judging  a  brother  firmly  and  gently,  but  they  shrink  from  the 
difficulties  of  applying  the  principle.  I  do  not  at  all  hide  the 
fact  that  there  are  difficulties,  but  they  are  no  greater  than 
those  of  the  application  of  the  actual  laws ;  the  absence  of  fine 
shades  in  our  laws  determines  a  summary  distribution  of  justice 
which  we  often  feel  to  be  bitterly  unjust,  the  more  law  the  more 
injustice;  sum  mum  jus  summa  injuria. 

The  opposition  which  results  from  the  feeling  of  the  diffi- 
culties of  the  task  is  not  great — time  will  correct  it.  What  is 
more  disturbing  is  the  mental  attitude  of  certain  jurists.  I 
have  read  somewhere  that  a  professor  of  penal  law  had  said  in 
a  discussion  on  the  limits  of  penal  responsibility :  "  The  crimi- 
nal is  he  whose  deed  arouses  our  feelings  of  indignation;  the 
fool  is  he  who  inspires  our  pity !  "  Here  you  have  a  precise 
criterion :  count  the  tears  of  your  audience  and  you  will  be  able 
to  determine  exactly  the  responsibility  of  the  accused ! 

I  must  ask  pardon  for  these  pages,  which  may  seem  to  many 
a  useless  digression.  I  feel,  on  the  contrary,  that  they  bear 
directly  upon  my  subject,  not  only  because  the  physician  is 
deemed  an  expert  in  these  matters,  but  because,  as  I  have  tried 
to  show,  the  same  principles  ought  to  direct  our  conduct,  when 
we  sit  in  judgment  upon  our  fellows,  whether  it  is  a  question 
of  education  or  of  penal  repression.  We  shall  find  the  same 
idea  in  therapeutics.  Wherever  there  is  mental  deviation,  one 
must  have  recourse  to  moral  orthopedia.  It  can  vary  in  its 
methods,  but  it  ought  to  be  the  same  in  its  tendencies. 

Let  us  hope  that  some  day  the  truth  taught  by  anthropology 
and  psychology  will  triumph  over  the  prejudice  and  the  oppo- 
sition that  have  blocked  its  road. 


80  PSYCHIC   TREATMENT 


CHAPTER   VII 

Monistic  Conception — Passivity  of  the  Organism — Absence  of  True 
Spontaneity — Mechanism  of  the  Reflex — Psychology  is  Only  a 
Chapter  of  Biology — Interpolation  of  Conscious  Acts  in  the  Reflex 
Arc — Mental  States  Have  Always  a  Material  Substratum — The 
Ideogenic  and  Somatogenic  Origin  of  Mental  States — Reciprocal 
Influence  which  the  Moral  and  the  Physical  Exercise  Upon  One 
Another — The  Possibility  of  Acting  on  these  Mental  States  by 
Physical  Means  and  by  Moral  Influence :  Efficacy  of  the  Latter 

THO  these  generalities  seemed  so  necessary  in  my  eyes,  I 
do  not,  nevertheless,  wish  to  linger  over  them,  and  I  hasten  to 
return  to  my  subject — that  is,  to  medicine.  But  it  is  a  medicine 
of  the  mind  that  I  have  in  view,  and  we  shall  find  ourselves 
constantly  meeting  such  terms  as  mind  and  body,  moral  and 
physical,  all  expressions  marking  a  certain  duality  of  the  human 
being.  They  all  have  to  do  with  the  comprehension  and  exami- 
nation of  what  becomes  of  the  conceptions  of  mental  pathology 
when  one  considers  them  in  the  light  of  monism. 

In  the  monistic  conception,  man  is  an  entity;  he  is  only  a 
functioning  organism,  reacting  under  the  influence  of  innu- 
merable internal  or  external  stimuli.  The  body  is  entirely 
composed  of  cells.  Therefore,  no  one  of  these  microscopic 
organisms  is  capable  of  spontaneous  activity.  The  cell  does 
not  act,  it  reacts;  the  total  absence  of  stimuli  would  mean 
physiological  death. 

Let  us  glance,  for  instance,  at  the  muscular  cell,  or  the  ag- 
gregate of  cells  that  we  call  the  muscles.  The  striated  muscles, 
during  life,  are  obedient  to  the  stimuli  coming  from  the  brain, 
or  to  what  is  commonly  called  the  voluntary  influx.  They  can 
respond  to  mechanical,  chemical,  and  electrical  stimuli.  The 
smooth  muscles  of  the  organs  of  vegetative  life  are  exempt 
from  the  influence  of  the  will,  but  their  contractions  are  started 
up  in  the  same  way  by  direct  or  reflex  irritations. 


OF  NERVOUS   DISORDERS  81 

And  the  brain  itself,  this  king  of  our  organs,  which  imperi- 
ously commands  the  whole  army  of  muscles,  is  also  passive. 
The  cerebral  cell  has  no  more  spontaneity  than  the  muscular 
fiber,  but  it  is  more  sensitive  and  delicate ;  it  is  a  more  expert 
workman  and  capable  of  performing  a  more  varied  task.  It 
also  acts  only  under  the  influence  of  stimuli,  of  secret  impul- 
sions, of  organic  sensations,  or  of  stimuli  which  are  received 
by  our  sense  organs,  those  fine  antennae  which  bring  us  into  re- 
lation with  the  outside  world.  Fading  vibrations,  the  results  of 
former  stimuli,  continue  in  the  form  of  dreams  in  sleep  which 
seems  to  be  cerebral  death. 

It  is  impossible  to  detect  in  man  or  in  animals  the  slightest 
trace  of  spontaneity.  On  waking  from  a  profound  sleep,  with- 
out being  conscious  of  dreams,  innumerable  stimuli  spring  up 
and  decide  the  complicated  functioning  of  our  organism.  The 
daylight  acts  upon  our  retina,  noises  upon  our  ears.  Imme- 
diately association  of  ideas  is  awakened.  It  is  time  to  get  up, 
and  the  idea  of  duty,  of  necessity,  and  rational  impulses  over- 
come, more  or  less  easily,  our  laziness,  and  our  dislike  of  dis- 
turbing our  pleasant  rest. 

The  impulse  being  given,  nothing  stops  this  cerebral  ac- 
tivity, and  until  night,  when  we  sink  into  refreshing  sleep,  we 
are  under  the  sway  of  these  divers  and  innumerable  stimuli  that 
vary  in  one  individual  or  another  according  to  the  mentality  of 
the  subject. 

Those  who  love  their  ease  stay  in  bed  until  the  hour  when 
their  duties  must  begin;  one  gives  in  to  this  desire  without  a 
thought,  another  can  not  keep  back  the  moral  goadings  which 
are  always  pricking  him  on  with  reproaches.  Sometimes  they 
will  be  strong  enough  to  make  him  jump  out  of  bed,  at  other 
times  they  will  only  be  sufficient  to  torment  his  comfort.  In 
the  activity  of  daytime  one  person  will  subordinate  all  his 
actions  to  the  selfish  tendencies  that  he  owes  to  ancestral  influ- 
ence and  to  his  education ;  the  other  will  obey  his  moral  senti- 
ments and  will  think  only  of  performing  his  duty  and  of  living 
for  others.  Both  are  the  slaves  of  their  motor  impulses.  The 
idea  of  determinism  only  becomes  repugnant  when  we  admit 
that  this  reaction  can  take  place  only  under  the  base  impulses 


82  PSYCHIC  TREATMENT 

of  the  senses,  in  the  sense  of  weakness.  As  soon  as  we  recog- 
nize that  a  feeling  of  beauty  or  an  ideal  aspiration  can  determine 
reaction,  I  no  longer  see  what  hinders  us  from  giving  up  the 
idea  of  free  will. 

We  see  before  us  only  animated  beings,  men  reacting  under 
the  influence  of  their  passions,  of  their  philosophic  or  religious 
ideas,  of  their  reason,  or  their  faith.  The  sad  thing  is  not  that 
this  necessary  and  undesirable  passivity  exists;  it  is  that,  in 
virtue  of  the  mentality  of  the  species,  it  should  manifest  itself 
too  often  in  a  wrong  way.  Strengthen  the  action  of  noble 
motives  and  this  happy  passivity  will  lead  to  moral  improve- 
ment ;  it  will  approach  the  ideal  toward  which  we  are  ever  striv- 
ing without  ever  being  able  to  reach  it.  The  physiological 
mechanism  by  which  this  reaction  is  made  is  physical  in  its 
essence,  and  that  is  why  our  mental  representations  and  the 
determinations  which  result  from  them  are  so  often  disturbed 
by  an  unhealthy  condition  of  the  body. 

This  reaction  takes  place  according  to  the  type  of  the  reflex. 

A  reflex  has  already  taken  place  when  the  motor  reaction 
of  a  cell  is  brought  under  the  influence  of  an  irritant.  Before 
the  centrifugal  motor  phenomenon  takes  place,  it  is  necessary 
to  admit  a  centripetal  sensory  stimulus.  We  call  it  a  simple 
medullary  reflex  when  we  quickly  withdraw  an  extremity  that 
has  been  tickled  or  pricked.  It  is  so  unconscious,  so  passive, 
that  it  takes  place  in  natural  or  artificial  sleep,  in  the  frog  de- 
prived of  its  brain,  and  in  the  man  whose  spinal  cord  is  cut. 

The  gesture  by  which  we  mechanically  respond  to  the  bow 
of  another  person  is  also  a  reflex,  an  almost  unconscious  reflex 
v.-hen  we  bow  abstractedly,  a  more  complex  reflex  when  we 
rapidly  take  in  by  the  mind's  eye  the  motives  that  prompted 
this  act  of  politeness. 

And  always  and  everywhere,  whether  it  is  a  case  of  the 
action  of  the  most  humble  organ  or  of  the  most  exalted  work- 
ings of  our  mind,  it  is  just  the  same  mechanism :  the  peripheral 
stimulus  strikes  the  extremity  of  the  end  organs  of  our  sensory 
nerves,  there  is  a  successive  transmission  in  the  hierarchies  of 
the  centers,  a  reflex  more  or  less  irradiated  among  the  groups 
of  sensory,  motor,  or  thinking  cells. 


OF   NERVOUS    DISORDERS  83 

A  compliment  tickles  our  self-esteem  and  influences  our  de- 
terminations. A  cutting  word  excites  our  wrath  and  makes 
our  blood  boil.  The  involuntary  gesture  is  associated  with  our 
mental  reactions.  The  phenomenon  is  so  material  that  it  is 
often  accessible  to  physical  analysis,  the  time  of  reaction  in- 
creasing with  the  length  of  the  reflex  arc. 

Physiology  must  undertake  the  work  of  pursuing  the  study 
of  these  reactions  of  the  organism,  whether  they  have  to  do 
with  nutrition  and  the  ordinary  reproduction  of  all  living 
beings,  or  with  the  simple  psychic  facts  that  are  observed  in 
animals,  or  the  marvelous  mechanism  of  the  human  mind  in 
its  highest  manifestations. 

Properly  speaking,  psychology  is,  then,  only  a  chapter  of 
physiology,  of  biology,  and  we  are  guilty  of  a  pleonasm  when 
we  speak  to-day  of  physiological  psychology. 

The  study  of  psychology  is  physiology  in  its  essence.  Thus, 
without  being  the  exclusive  property  of  physiologists  alone,  it 
requires  of  those  who  wish  to  devote  themselves  to  it  a  combi- 
nation of  anatomical  and  physiological  knowledge — in  a  word, 
biological  culture. 

The  literary  man,  who  knows  how  to  observe  and  to  de- 
scribe, the  artist,  the  philosopher,  the  priest,  can  make  judicious 
observations  on  their  personal  state  of  mind,  depict  the  psychic 
life  of  individuals  or  of  communities,  and  contribute  for  their 
part  to  the  knowledge  of  psychic  facts;  if  they  have  genius 
their  perspicacity  will  go  beyond  that  of  most  specialists,  but 
often  their  works  lack  the  physiological  point  of  view. 

Many  modern  psychologists  have  felt  the  necessity  for 
grounding  themselves  on  scientific  ideas,  and  one  sees  writers 
interviewing  physicians  and  alienists  in  order  to  give  their  de- 
scriptions the  documentary  value  of  a  medical  observation. 

It  is  possible  that  these  attempts  may  not  always  be  felici- 
tous, that  they  come  out  in  the  end  with  conceptions  that  are 
too  simplistic.  On  the  other  hand,  physicians,  strong  in  their 
scientific  equipment,  forget  that  the  culture  of  a  science,  how- 
ever wide  it  may  be,  is  not  sufficient  to  make  one  master  of  it. 
Thus  I  can  not  follow  the  alienist,  who,  like  Toulouse,  thinks 
to  monopolize  the  criticism  of  his  art  under  the  pretext  that 


84  PSYCHIC   TREATMENT 

only  the  physician  understands  anything  of  psychology!  We 
owe  much  to  writers,  to  religious  thinkers,  or  rationalists  who 
have  analyzed  the  human  soul,  and  if  I  dare  demand  of  psycho- 
logical writers  in  the  future  a  more  precise  knowledge  of 
biology,  it  is  with  the  lively  realization  that  we  have  no  right 
to  snatch  the  pen  out  of  their  hands. 

The  physiologists  have  made  some  mistakes  in  trying  to 
fortify  themselves  by  researches  in  vivisection  and  the  psychics 
of  physiology.  They  become  too  much  wrought  up  over  the 
unfortunate  frog  and  the  pain  that  is  suffered  in  our  labora- 
tories. They  have  left  to  others  the  task  of  investigating  the 
psychic  life,  and  it  is  they  who  have,  in  a  large  degree,  created 
the  irreconcilability  that  seems  to  exist  to-day  between  psy- 
chology and  physiology.  It  is  time  that  we  advanced  beyond 
this  false  position. 

The  physiologists  have  studied  in  animals,  generally  sleep- 
ing or  deprived  of  their  brains,  the  reaction  of  different  tissues 
under  the  influence  of  artificial  stimuli.  Sometimes,  stimulat- 
ing a  nerve  fiber  that  has  been  laid  bare,  they  have  noticed  dis- 
tant reactions  which  have  followed  the  irritation;  sometimes, 
sectioning  the  nerve  trunks,  they  have  interrupted  the  conti- 
nuity of  the  neuron  and  detected  the  disorders  that  followed  in 
consequence.  They  have  thus  been  able  to  determine  the  paths 
by  which  the  nerve  waves  travel.  Like  explorers  in  new 
countries,  they  have  pointed  out  the  lay  of  the  land,  have  noted 
the  natural  paths  of  communication,  and  have  drawn  up  a  sort 
of  map  of  the  region.  It  is  far  from  being  complete,  and  every 
day  it  has  to  undergo  some  alterations  which  often  discourage 
the  investigators.  But  at  last  we  have  reached  solid  ground, 
and  what  we  do  not  know  to-day,  the  explorer  of  to-morrow 
will  teach  us. 

But  alongside  of  this  conquered  country,  where  the  march, 
if  not  easy,  is  at  least  assured,  there  are  still  vast  stretches 
where  quicksands  seem  to  have  effaced  all  traces  of  our  prede- 
cessors. It  is  a  sandy  desert,  which  has  been  abandoned  to 
psychologists  and  philosophers ;  they  have  made  bold,  but  often 
imaginary,  voyages  across  it,  like  those  story-tellers  who  write 


OF   NERVOUS   DISORDERS  85 

novels  of  adventure  without  ever  having  set  foot  in  the  coun- 
try to  which  they  transport  their  hero. 

If  this  vague  and  uncertain  territory  of  psychology  were 
clearly  defined,  it  would  be  easy  for  the  physiologist  to  continue 
his  modest  experiments  while  remaining  agnostic  in  regard  to 
the  things  of  the  spirit.  He  would  maliciously  let  the  meta- 
physician stray  away  and  flounder  in  the  sand,  and  when  invited 
to  take  part  in  the  exploration,  he  would  excuse  himself  by 
saying:  "  That  is  not  in  my  line." 

But  the  frontier  between  physiology,  in  the  limited  sense  of 
the  word,  and  psychology  is  not  marked  by  a  line  which  one  can 
refuse  to  step  over.  There  are  no  precise  boundaries,  but  re- 
ciprocal entanglements.  Every  moment,  while  following  up 
physiology,  one  loses  the  way  and  can  not  find  it  until  he  has 
set  foot  on  psychological  ground. 

As  soon  as  experiment  or  physiological  observation  takes  a 
higher  animal  or  man  for  its  object,  there  is  an  interpolation  of 
acts  of  consciousness  in  the  reflex  arc.  It  is  still  worse  when 
the  physician  is  confronted  by  a  sickly  body  and  phenomena 
that  are  complex  and  foreign  to  psychopathology.  The  physi- 
ology of  our  laboratories  then  becomes  wholly  insufficient;  it 
appears  childish  in  its  evident  obviousness. 

Whether  he  wants  to  or  not,  the  physician  ought  to  be  a 
psychologist,  and  in  practise  he  will  see  that  his  knowledge  of 
the  human  heart  is  more  useful  than  his  ability  in  questions  of 
normal  or  pathological  physiology.  That  is  why,  tho  always 
considering  the  mental  states  as  cerebral,  and  insisting  on  the 
principle  of  concomitance,  I  hold  to  the  terms  moral  and  phy- 
sical, psychic  and  somatic,  psychological  and  physiological. 

In  these  scientific  classifications  new  distinctions  have  been 
created.  Some  spiritualists  find  themselves  constrained  to  rec- 
ognize that  certain  chapters  of  psychology  are  open  to  experi- 
mentation and  calculation,  but  they  assign  narrow  limits  to  phy- 
siological psychology.  They  admit  that  there  is  beyond  it  a 
higher  psychology,  a  study  of  the  life  of  the  soul,  where 
one  must  proceed  by  introspection,  and  they  seem  tempted  to 
snatch  this  branch  from  the  biologist  and  hand  it  over  to  the 
theologian. 


86  PSYCHIC   TREATMENT 

It  seems  to  me  that  this  is  a  mistake.  Biology  is  a  study  of 
life  in  all  its  manifestations,  and  as  such  it  has  the  right  to  ap- 
proach psychological  problems,  not  only  by  the  path  of  pre- 
cision, which  is  often  false  in  experimentation,  but  by  that  of 
induction  and  introspection. 

The  law  of  concomitance  demands  that  there  shall  always  be 
structural  modification  of  the  nerve  cell  when  there  is  a  mental 
phenomenon ;  there  is  chemical  reaction,  production  of  heat  and 
electricity,  expenditure  of  force  and  fatigue,  all  physical  phe- 
nomena, which,  if  one  considers  the  reaction  in  itself,  would 
seem  to  interdict  all  differentiation  between  the  mind  and  the 
body. 

But  the  distinction  is  born  again  and  clearly  established 
when  one  analyzes  the  stimuli  which  have  determined  the  re- 
action, and  when  one  examines  whence  they  come  and  whither 
they  tend. 

To  be  sad  is  a  mental  state ;  it  is,  therefore,  a  psychic  mani- 
festation, but  we  recognize  in  it  a  physical  substratum,  since 
every  act  of  consciousness  must  have  a  corresponding  cerebral 
state.  In  its  essence  the  phenomenon  is  psychophysical,  as  is 
everything  that  takes  place  in  our  mentality.  But  the  expres- 
sion of  it  is  psychic,  it  is  translated  by  discouraged  words  and 
by  abnormal  volitions. 

On  the  other  hand,  this  disposition  of  mind  can  be  provoked 
by  mental  representations  and  by  ideas ;  it  is,  therefore,  of  ideo- 
genic  origin.  It  can,  on  the  other  hand,  be  due  to  the  action 
of  a  poison  affecting  the  nerve  centers;  we  then  recognize  a 
somatic  cause  for  it. 

When  we  say  of  an  individual  that  he  raves,  we  character- 
ize at  the  same  time  his  mental  state  and  the  cerebral  trouble 
that  is  indicated.  We  perceive  at  the  same  time  the  two  sides 
of  the  phenomenon,  but,  sometimes,  this  raving  is  the  result  of 
unbounded  joy,  it  is  psychological  in  its  origin ;  at  other  times 
it  is  due  to  alcoholic  intoxication,  or  the  absorption  of  opium, 
and  it  is  then  somatic  from  the  point  of  view  of  its  cause. 

To  the  eyes  of  most  people  pain  is  physical.  The  thought 
springs  immediately  to  the  cause  which  is  in  fact  generally  ma- 
terial, and  sick  people  make  a  great  effort  to  have  not  only  the 


OF   NERVOUS   DISORDERS  87 

unquestioned  reality  of  their  sensation  recognized,  but  also  the 
absolute  materiality  of  the  phenomenon.  This  popular  view  is 
too  summary.  To  suffer  presupposes  two  things :  on  the  one 
hand  a  material  condition  of  certain  groups  of  nerve  cells,  a 
physical  phenomenon ;  on  the  other  hand  a  sensation  perceived, 
a  process  that  is  psychic  in  its  essence. 

The  existence  of  pain  does  not  by  any  means  inform  us  con- 
cerning its  cause.  To  seek  this  cause  is  an  ulterior  problem 
whose  solution  does  not  always  belong  to  the  patient.  This 
same  pain,  as  real  as  a  conscious  act,  real  also  as  a  concomitant 
cerebral  state,  may  have  as  its  cause  a  lesion  of  the  tissues,  or 
an  irritation  attacking  the  neuron  in  its  continuity ;  it  may,  per- 
haps, be  due  only  to  mental  representations,  to  fixed  ideas,  or 
to  autosuggestions  born  in  a  psychological  way.  The  pain  in 
itself  is  none  the  less  real  on  this  account. 

We  are  in  the  presence  of  a  phenomenon  of  a  physiological 
nature,  in  the  strict  sense  of  the  word,  when  the  electric  irri- 
tation of  the  inferior  cardiac  branch  of  the  sympathetic  causes 
acceleration  of  the  heart  beat.  We  drop  right  into  genuine 
psychology  when  an  emotion  causes  the  palpitations. 

Tears  can  flow  by  simple  mechanical  or  chemical  irritation 
of  the  conjunctiva;  they  accompany  our  sorrows  and  our  joys. 

The  nervous  crisis  of  the  venereal  orgasm  reacts  furiously 
on  all  the  organs,  and  the  storm  can  be  let  loose  just  as  well  by 
representations  that  are  artificially  produced  as  by  the  slow 
work  of  the  generative  organs. 

The  appetite  is  normally  created  by  the  need  which  the 
organism  feels  of  renewing  its  stock  of  energy,  but  it  can  be 
stimulated  by  the  sight  of  an  appetizing  dish  or  by  a  gustatory 
memory;  it  can  be  suppressed,  on  the  contrary,  by  a  moral 
emotion,  or  by  disgust.  It  makes  little  difference  whether  the 
disgust  be  provoked  by  a  sense  of  smell  or  by  a  purely  mental 
representation,  due  to  a  verbal  suggestion.  It  is  not  without 
reason  that  one  dreads  to  have  at  the  table  a  medical  "  saw- 
bones "  who  confides  to  his  neighbors  the  secrets  of  the  oper- 
ating room  and  of  the  hospital.  Vomiting  may  even  occur  as 
the  result  of  such  a  reaction,  which  is  ideogenic  in  its  origin. 

It  is  important,  then,  to  recognize  that  the  same  physio- 


88  PSYCHIC   TREATMENT 

logical  manifestations  and  the  same  pathological  troubles  may 
have  physical  or  moral  causes ;  it  is  self-evident  that  they  may 
be  associated. 

These  ideas  ought  to  be  kept  in  mind  in  studying  the  re- 
ciprocal influence  which  the  physical  and  the  moral  are  con- 
stantly exerting,  one  upon  the  other. 

In  ordinary  speech  this  word  "  moral  "  has  a  too  restricted 
meaning.  One  understands  by  it  hardly  anything  else  except 
the  mental  characteristics,  such  as  a  lively  or  sad  disposition. 
One  tries  to  brighten  the  moral  tone  of  an  invalid  or  a  person 
in  sorrow.  One  forgets  that  a  state  of  bodily  ill-health  not 
only  modifies  our  mental  condition  in  the  pessimistic  or  opti- 
mistic sense,  but  that  it  can  alter  all  our  cerebral  functions  and 
disturb  our  intellectual  and  moral  life. 

Organic  disorders,  whether  by  known  channels  or  by  those 
that  are  still  mysteries  to  us,  affect  our  brain ;  they  involve  our 
reason,  distort  mental  images,  and  pervert,  completely  or  in 
part,  the  delicate  mechanism  of  our  psychic  life. 

Intoxicated  by  alcohol  or  other  poisons,  the  most  pious  man 
will  commit  extravagances.  Under  the  influence  of  the  meno- 
pause or  senile  changes  of  the  brain,  the  most  modest  and  vir- 
tuous wife  may  be  the  prey  of  the  most  strange  and  libidinous 
obsessions. 

An  old  man  of  established  virtue  will  fall  in  love,  rather  late 
in  life,  with  a  common  dancing-girl,  and  abandon  his  family. 
A  young  man  will  lose  all  feeling  of  affection  for  his  parents 
and  find  his  love  changing  to  aversion,  even  when,  with  such 
reason  as  remains  intact,  he  recognizes  that  nothing  has  hap- 
pened to  disturb  the  family  relation. 

Nothing  is  as  sad  as  this  dependence,  not  only  of  the  intel- 
lectual being  but  of  the  moral  personality,  in  the  presence  of 
the  lesions  which  the  brain  cells  momentarily  or  definitely 
undergo. 

Fortunately  this  structural  modification  which  leads  to  men- 
tal trouble  does  not  always  result  from  somatic  influences.  If 
in  many  cases  the  bondage  is  complete  and  inevitable  there  are 
others  where  one  meets  the  beneficent  intervention  of  the  mind, 
of  ideas,  and  of  convictions. 


OF   NERVOUS    DISORDERS  89 

Dualistic  spiritualism  describes  the  supremacy  of  the  soul 
as  it  is  when  it  escapes  from  the  restraint  of  the  body  abandon- 
ing it  in  triumphant  flight  when  our  mortal  remains  shall  return 
to  dust.  The  conception  is  poetic,  but  does  it  correspond  to 
the  reality? 

Why  does  this  old  man  who  has  had  an  attack  of  apoplexy 
become  not  only  a  little  petulant,  but  selfish  and  bad?  Why 
should  he,  who  has  until  that  time  been  a  good  husband  and 
father,  now  cause  his  whole  family  to  suffer  martyrdom  ?  Why 
does  he  resist  the  gentle  remonstrances  of  his  most  intimate 
friends  ? 

Because  his  mentality  is  changed;  because  his  brain  is 
troubled  in  its  thinking  part,  where  those  vague  perceptions  of 
pleasure  and  pain,  which  we  call  our  sentiments,  are  born.  Do 
not  lecture  this  poor  old  man  who  has  become  vicious  on 
account  of  cerebral  disorganization;  he  can  not  help  it,  and 
you  ought  to  submit  until  his  death  to  the  fatal  consequences 
of  this  incurable  diseased  condition.  Neither  must  you  be 
severe  with  the  other,  the  young  man  who  has  become  vicious 
by  reason  of  his  education  and  hereditary  tendencies.  Doubt- 
less his  brain  in  an  autopsy  would  not  present  the  same  thick- 
ening of  the  meninges,  but  if  you  could  detect  the  minute 
intercellular  disorder  you  would  see  that  there  was  a  lesion 
there  also — slight,  I  grant  you,  but  nevertheless  real. 

But  whereas  in  the  case  of  our  old  man  your  trouble  would 
be  wasted  if  you  described  to  him  the  beauties  of  altruistic 
sentiments,  you  could  succeed  in  leading  the  young  man  into 
a  better  way.  Moral  ideas  act  as  an  antidote  as  well  when  the 
mentality  is  perverted  by  a  somatic  cause  as  when  the  disorder 
results  from  an  idiogenic  cause.  The  prognosis  depends  more 
upon  the  severity  of  the  lesion  than  upon  whether  it  is  due  to 
a  physical  or  psychic  evil. 

In  acute  alcoholic  intoxication  the  mental  state  is  profoundly 
changed,  but  if  the  intoxication  is  not  complete  the  individual 
can  regain  his  self-control.  Under  the  influence  of  an  emotion, 
as  of  shame,  he  is  suddenly  brought  to  his  senses. 

An  invalid  who  has  become  impatient  and  disagreeable  by 
reason  of  his  pain,  even  tho  his  trouble  may  be  distinctly  mental 


90  PSYCHIC   TREATMENT 

in  character,  can  suddenly  control  himself  when  he  perceives 
that  he  has  gone  too  far  and  has  keenly  hurt  those  who  are 
dear  to  him. 

It  is  because  the  Soul  has  recovered  its  liberty,  you  will  say, 
Why  has  she  not  kept  it  from  the  first  if  she  is  so  all  powerful  ? 

No ;  if  we  sometimes  succeed  in  escaping  from  these  mate- 
rial influences  and  emerge  from  a  bad  disposition  it  is  because 
there  is  some  change  in  our  brain.  This  cure  may,  perhaps, 
be  due  to  the  wholly  material  phenomenon  of  disintoxication, 
as  in  the  case  of  the  drunkard  who  has  slept  himself  sober  and 
whose  moral  personality  has  reappeared;  it  may,  perhaps,  be 
helped  by  rest,  or  by  the  action  of  therapeutic  remedies,  but  it 
can  also  result  from  an  idea,  or  of  a  mental  representation  that 
has  come  through  the  association  of  ideas. 

Moral  ideas,  born  of  memory  or  awakened  by  a  kind  word, 
engender  in  the  thinking  brain  intense  work,  material  activity, 
and  a  succession  of  physicochemical  processes.  The  groups  of 
intoxicated  cells  that  have  been  changed  by  a  diseased  condition 
are  influenced  in  the  general  tendency  toward  repair;  their 
chemistry  is  modified,  and  the  cellular  body  returns  either 
rapidly  or  slowly  to  its  normal  state. 

By  his  helpful  words  and  his  councils  as  a  man  of  sense 
the  physician  can  often  influence  a  patient  whose  mentality  is 
disturbed  as  well  as  a  so-called  sane  person  who  does  not  know 
how  to  resist  his  impulses.  In  both  cases  he  changes  the 
mentality  of  the  subject,  and,  in  virtue  of  the  principles  of 
concomitance,  this  change  presupposes  modifications  of  the 
chemistry  of  the  brain. 

In  the  presence  of  the  same  mental  condition,  such  as  sad- 
ness, sullenness,  irritability,  or  violence,  the  physician  can  vary 
his  methods  according  to  the  indications  of  the  moment;  he 
may  have  recourse  to  the  most  varied  physical  measures,  or 
he  may  limit  himself  to  the  influence  of  psychotherapy ;  often 
he  associates  them. 

We  find  ourselves  in  the  presence  of  a  patient  with  severe 
uremic  intoxication.  He  is  in  a  state  of  continual  agitation; 
he  jumps  out  of  bed  in  spite  of  the  entreaties  of  his  family; 
he  refuses  food  and  medicine,  and,  if  his  relatives  insist,  he 


OF   NERVOUS    DISORDERS  91 

abandons  himself  to  violence.  The  physician  arrives,  and  sur- 
rounds the  patient  with  an  atmosphere  of  calm  kindness;  he 
puts  him  back  into  bed  without  trouble  and  gets  him  to  drink 
a  glass  of  milk. 

The  family  is  delighted  at  this  sudden  and  magical  change, 
but  they  are  also  troubled  by  it.  How  is  it  that  the  patient  can 
control  himself  when  the  physician  is  there,  and  can  be  as 
gentle  as  a  lamb,  whereas  when  he  is  alone  with  those  who 
love  him  he  seems  to  take  a  malicious  pleasure  in  giving  them 
trouble !  This  is  a  natural  reflection  which  occurs,  and  I  have 
often  seen  the  friends  around  the  patient  deeply  wounded  by 
his  contradictory  conduct. 

Yet,  on  the  whole,  no  reproach  should  be  put  upon  the  poor 
patient.  His  brain  is  under  the  influence  of  toxins  resulting 
from  insufficient  purification  of  the  blood ;  his  bodily  functions 
are  badly  performed,  and  his  mentality  is  disturbed.  His  men- 
tal vision  is  not  clear;  he  is  vicious  by  reason  of  intoxication, 
and  is  not  only  disobedient  and  wilful  but  provoking.  It  is, 
indeed,  intentionally,  and  often  with  a  cruel  delight  and  a  sar- 
donic smile  upon  his  lips,  that  he  jumps  out  of  bed  the  moment 
that  the  physician  has  turned  his  back. 

Why  is  it  that  the  physician  who  is  immediately  recalled 
can  succeed  again?  Why  does  his  calming  influence  become 
more  lasting  up  to  the  point  of  suppressing  all  such  accidents  ? 
Because  he  is  a  stranger;  because,  in  the  eyes  of  the  patient, 
he  holds  a  certain  moral  authority,  and  because  he  knows  how 
to  act  with  gentle  persuasion. 

The  relatives,  on  the  contrary,  no  longer  have  this  sug- 
gestive influence.  The  patient  knows  their  qualities,  but  also 
their  faults ;  he  takes  their  advice  in  the  wrong  way ;  on  the 
other  hand,  the  people  around  him  lack  the  necessary  calmness. 
Madame  is  weak  and  over-emotional,  and  she  forces  the  patient 
into  bed  brusquely  and  with  a  sort  of  dull  impatience.  Thus 
the  patient  refuses  to  obey.  He  gains  control  over  himself 
when  it  is  the  gentle  hand  of  the  physician  which  leads  him. 

The  same  effect,  less  rapid  but  often  more  durable,  may 
be  obtained  by  material  treatment,  by  milk  diet,  by  drinking  a 


92  PSYCHIC  TREATMENT 

great  deal  of  fluid  to  cleanse  the  system,  by  the  diuretic  action 
of  digitalis  and  diuretin. 

The  physician  often  has  to  choose,  in  a  few  minutes,  at  the 
patient's  bedside,  between  these  measures:  physical  treatment, 
or  medicaments  which  can  only  effect  the  mentality  through 
the  medium  of  the  body,  and  pure  psychotherapy  which,  in 
acting  psychically,  is  no  less  efficacious. 

And  we  must  never  forget  that  in  the  two  cases  there  is  a 
mental  change  and  a  cerebral  change. 

It  is  by  the  influence  of  the  physical  on  the  moral  that  your 
intoxicated  patient  is  rebellious,  impatient,  and  vicious.  You 
can  bring  him  back  to  reason  by  treating  his  body  only,  but 
you  can  employ  the  action  of  the  moral  over  the  physical  and 
reach  the  same  result — namely,  a  favorable  change  of  the 
pathological  mentality. 

Sadness  is  often  the  result  of  a  fatigued  condition.  Then 
repose  would  be  the  physical  remedy;  it  may  be  enough,  but 
it  is  useful  to  combine  moral  influence  with  it ;  it  may  even  be 
all  that  is  necessary  if  it  is  impossible  to  take  any  rest.  The 
same  state  of  mind  may  result  from  moral  troubles.  Then  you 
are  disarmed  from  the  physical  point  of  view,  but  you  have  to 
aid  you  in  your  role  of  physician  the  powerful  support  which 
your  sympathy  for  the  patient  gives  you,  your  constant  altru- 
ism, and,  I  do  not  hesitate  to  say,  these  are  the  more  efficacious. 


OF  NERVOUS   DISORDERS  93 


CHAPTER   VIII 

Slavery  of  the  Mind  in  the  Presence  of  Certain  Diseases :  General 
Paralysis,  Meningitides,  Epilepsies,  Intoxications  —  Possibility  of 
Escape  from  It  by  Education  of  the  Moral  Ego  —  Pinel ;  Curative 
Action  of  the  Work  of  Logical  Reflection  —  The  Difficulty  of  Psy- 
chotherapy in  the  Insanities :  its  Efficacy  in  the  Psychoneuroses — 
Necessity  of  Clear  Ideas  on  the  Genesis  of  these  Diseases  —  The 
Importance  of  Psychotherapy  in  Every  Province  of  Medicine 

THE  idea  that  the  moral  acts  on  the  physical  is  by  no  means 
new,  and  physicians  seem  to  be  in  a  good  position  to  prove  the 
value  of  this  influence.  But  their  constant  preoccupation  with 
the  human  animal  often  blinds  them,  and  makes  them  put  the 
inverse  influence  in  the  foreground.  I  have  seen  physicians 
who  did  not  believe  in  the  power  of  education  stop  short  at  a 
sort  of  narrow  determinism  which  would  render  the  individual 
a  slave  to  the  innate  deterioration  of  his  mentality  and  to  the 
variations  to  which  it  might  be  subjected  under  the  influence 
of  disease. 

True  determinism  admits  this  original  deterioration,  but  it 
recognizes  the  ever-powerful  action  of  ideas,  and  of  intellec- 
tual and  moral  culture. 

It  is  often  possible  for  us,  thanks  to  the  influence  of  the 
moral  on  the  physical,  to  escape  from  the  clutches  of  the  dis- 
temper, combat  the  effects  of  heredity,  and  struggle  against 
disease. 

There  are  diseases  in  which  what  we  call  the  soul  is  in  the 
most  complete  bondage  to  the  body ;  that  is  to  say,  the  cerebral 
deterioration  is  so  profound  that  it  can  not  be  corrected  by 
psychic  influence  or  by  the  curative  action  of  ideas. 

The  most  striking  example  is  that  of  general  paresis.  This 
terrible  affection  first  of  all  attacks  the  cortical  layer  of  the 
brain.  The  lesion  extending  through  the  entire  cortex  produces 


94  PSYCHIC   TREATMENT 

not  only  motor  and  sensory  paralysis,  tremors,  difficulties  with 
speech  or  writing,  and  pupillary  symptoms;  it  also  gives  rise 
to  auditory,  visual,  and  gustatory  hallucinations ;  it  creates  con- 
ditions of  neurasthenia,  melancholia,  hypochondria,  and  acute 
mania.  Often  the  insanity  takes  the  form  of  delusions  of 
grandeur;  it  terminates  in  dementia,  in  psychic  and  bodily 
collapse.  Fortunately  the  clouding  of  the  intellect  prevents 
the  patient  from  appreciating  his  fall,  but  sometimes  lucidity 
persists,  and  the  unfortunate  being  witnesses,  with  keen  despair, 
the  annihilation  of  his  mental  self. 

The  situation  is  the  same  in  some  other  affections  that  con- 
cern the  higher  portion  of  the  brain,  in  the  meningitides  and 
epilepsies,  where  it  is  by  no  means  rare  to  see  the  convulsive 
attacks  replaced  by  what  has  been  called  "  psychic  equivalents  " 
of  a  melancholic  or  maniacal  nature,  with  criminal  impulsions, 
and  delusions  of  persecution. 

The  stubbornness  and  ferocious  selfishness  of  certain  epilep- 
tics is  not,  as  one  often  thinks,  a  fault  corrigible  by  education ; 
it  is  a  symptom  of  cerebral  trouble.  I  have  sometimes  been 
skeptical  concerning  the  fatality  of  this  pathological  egoism, 
and  I  have  exhausted  the  resources  of  psychotherapy  to  awaken 
in  these  patients  those  sentiments  of  altruism  that  are  the  most 
instinctive,  such  as  are  confined  to  the  friends  they  love  the 
most.  I  might  have  spared  myself  the  trouble;  they  listened 
to  me,  they  understood  me  intellectually,  but  a  moment  later 
the  patient  surrendered  himself  to  the  control  of  the  "  morbus 
sacer  " — docile  slave  of  his  diseased  brain. 

But  even  in  these  cerebral  maladies  due  to  microscopic 
organic  lesions,  one  recognizes  the  influence  of  the  mind.  This 
does  not  mean,  alas!  that  psychotherapy  can  check  their  ad- 
vance, but  it  is  easy  to  see  that  the  trouble  develops  along  the 
line  of  the  mentality,  innate  or  acquired.  The  previous  faults 
of  character  manifest  themselves.  One  finds  in  the  deluded 
person  the  selfishness  which  withered  his  character  in  his 
healthy  state  and  the  tendency  to  fits  of  rage ;  those  who  were 
gentle  and  weak-minded  will  tend  toward  the  melancholic  and 
hypochondriacal  forms.  The  stronger  minds,  those  who  were 
brave  and  accustomed  to  control  their  impulses,  will  endure  the 


OF   NERVOUS    DISORDERS  95 

anguish  and  will  succumb  only  to  the  deadliest  strokes.  The 
horrible  slavery  which  makes  our  mentality  depend  upon  our 
brain  shows  itself  also  in  the  insanities,  strictly  so  called,  in  the 
melancholias,  the  manias,  and  the  various  constitutional  and 
acquired  dementias,  and  in  all  the  mental  diseases  where  there 
must  be  a  profound  structural  deterioration,  altho  it  may  elude 
our  methods  of  investigation. 

The  various  intoxications,  when  they  reach  a  certain  degree, 
act  in  the  same  fatal  way  upon  the  brain,  and  the  psychic  part 
of  us  succumbs  completely  to  the  influence  of  chloroform,  ether, 
or  alcohol. 

But  here  one  already  sees  the  dawn  of  the  psychic  influence. 
The  effect  of  these  poisons  will  vary  according  to  the  mental 
state  of  the  subject.  He  will  fall  asleep  more  easily  if  he  is 
confident  and  tranquil;  he  will  resist,  on  the  other  hand,  if 
he  is  agitated. 

In  the  diseases  of  the  mind  we  can  also,  to  a  certain  degree, 
prevent  ourselves  from  working  for  our  own  cure. 

There  is,  in  the  healthy  culture  of  the  intellectual  and  moral 
ego,  a  prophylactic  and  curative  remedy  against  mental  de- 
rangement. I  do  not  exaggerate  this  influence  in  any  degree. 
Who  would  pretend  that  he  owes  his  mental  integrity  to 
the  moral  efforts  he  has  made,  or  who  would  dare  to  accuse 
the  unfortunate  psychopaths  of  having  neglected  his  moral 
education  ? 

But  this  preservative  virtue  is  implied  in  the  curative  effi- 
cacy of  the  remedy.  I  have  often  seen  psychopaths  take  hold 
of  themselves,  break  the  bonds  which  held  them,  and  regain, 
step  by  step,  the  lost  ground,  not  only  under  the  influence  of 
time,  nor  by  measures  of  bodily  hygiene,  nor  by  the  natural 
process  of  the  disease  which  is  essentially  cyclical,  but  by  the 
clear  sight  of  the  end  to  be  obtained  and  the  roads  which  lead 
to  it. 

The  psychological  analysis  of  one's  self,  when  it  is  well 
directed  and  made  with  a  voluntary  optimism  and  with  the  sym- 
pathetic aid  of  the  physician,  who  enjoys  not,  to  be  sure,  the 
perfection  of  psychic  health — that  is  impossible — but  an  aver- 
age state  of  mental  well-being,  is  useful  in  diseases  of  the  mind. 


96  PSYCHIC   TREATMENT 

It  is  more  efficacious  than  all  the  physical  means  by  which 
efforts  are  made  to  give  them  health.  Many  alienists  seem  to 
have  forgotten  this  moral  influence,  this  power  of  ideas.  And, 
nevertheless,  these  truths  are  not  a  thing  of  to-day.  They  were 
expressed  with  much  heat  by  Pinel,  the  illustrious  physician 
and  man  of  worth,  who,  at  Bicetre  and  at  la  Salpetriere,  struck 
the  chains  from  the  insane. 

Before  Pinel's  day  physical  treatment  was  looked  upon  as 
the  only  thing  of  value.  It  is  his  glory  to  have  first  introduced 
psychotherapy  in  the  treatment  of  mental  diseases.  "  It  is 
necessary,"  said  he,  "  to  isolate  the  patient  from  his  family  and 
friends,  to  take  him  away  from  all  those  whose  imprudent 
affection  may  keep  him  in  a  state  of  perpetual  agitation,  or 
even  aggravate  the  danger;  in  other  words,  it  is  necessary  to 
change  the  moral  atmosphere  in  which  the  insane  person  is  to 
live.  But,  above  all,  the  physician  ought  to  be  interested  in 
the  inner  life  of  the  patient,  to  trace  out  the  origin,  often  psy- 
chic, of  his  condition,  to  await  the  favorable  moment  to  inter- 
vene, and  to  find  out  with  care  what  tract  in  his  mental  life 
remains  intact,  and  to  remember  it  in  order  to  gain  control  of 
it,  and  to  point  out  to  the  patient  himself,  sometimes  by  a  very 
simple  reasoning,  sometimes  by  concrete  facts,  the  chimerical 
nature  of  the  ideas  which  possess  him ;  in  some  places  one  can 
employ  a  ruse  or  resort  to  a  clever  subterfuge  to  gain  his  con- 
fidence, enter  a  little  into  his  illusion,  in  order  to  cure  him  of 
it  by  degrees.  Sometimes  it  is  necessary  to  break  down  the 
resistance  that  he  offers,  and  to  have  recourse  to  physical  force ; 
but  even  then  one  should  avoid  useless  pain.  The  physician 
and  guardians  ought  to  appear  to  the  insane  person  as  persons 
endowed  not  only  with  a  material,  but,  above  all,  with  a  moral 
superiority.  It  is  by  these  means  that  they  will  succeed  in 
arousing  in  him  the  further  effort  of  reflection." 

Capo  dTstria,1  from  whom  we  borrow  this  exposition,  holds 
that  this  moral  treatment,  extolled  by  Pinel,  does  not  offer  any- 
thing very  original.  He  reproaches  Pinel  for  having  believed 
that  the  insane  person  can  be  rendered  docile  by  an  effort  of 


1  Revue  Scientifique,  No.  30,  ao  Mai,  1899. 


OF   NERVOUS    DISORDERS  97 

logical  reflection.  "  It  was  difficult  to  Pinel,"  said  he,  "  to 
avoid  this  error  of  psychological  analysis ;  he  did  not  have  the 
discoveries  of  modern  psychological  physicians  in  the  domain 
of  suggestion  to  illumine  his  judgment." 

"  If  the  insane  person,"  he  adds,  "  gives  in  to  the  strong 
will  of  the  physician  it  is  more  often  on  account  of  his  own 
mental  weakness,  and  because  the  prestige  acquired  by  those 
who  care  for  him  is  in  direct  ratio  to  his  psychological  des- 
titution." 

Nevertheless,  with  all  deference  to  modern  hypnotizers  and 
suggestors,  it  is  Pinel  who  is  right.  Without  doubt,  the  influ- 
ence which  we  have  over  our  fellows  it  not  always  rational ;  we 
often  overwhelm  them  by  the  prestige  which  they  recognize  in 
us,  and  they  yield  the  more  easily  to  our  injunctions  according 
as  they  are  more  mentally  weak.  We  have  the  right  and  the 
duty  sometimes  to  profit  by  this  situation  if  it  is  to  cure,  or  to 
comfort,  or  to  relieve  them ;  but  our  influence  is  much  more 
powerful  and  durable  if  the  patient  has  partially  preserved  his 
good  sense  and  can  work  toward  his  own  cure  along  the  lines 
of  logical  reflection.  To  make  a  patient  obey  and,  for  this  end, 
to  take  advantage  of  his  psychological  misery  in  order  to  domi- 
nate him,  is  by  no  means  to  cure  him.  To  attain  this  cure 
there  is  need  of  time,  hygienic  measures,  and  a  devoted  and 
unremitting  psychotherapy  which  utilizes  for  the  uplifting  of 
the  patient  every  ray  of  reason  that  remains  to  him.  This  situ- 
ation is  less  rare  than  people  imagine.  Many  of  the  insane  are 
more  or  less  monomaniacs,  and  preserve  their  logic  and  a  great 
deal  of  good  sense  which  ought  to  be  intelligently  utilized.  The 
end  to  be  obtained  is  not  to  make  the  patient  stupidly  sug- 
gestible ;  it  is,  on  the  contrary,  to  raise  him  up  and  to  reestab- 
lish him  as  master  of  himself. 

What  we  have  quoted  forms  a  fine  passage  in  Pinel's 
"  Treatise  on  Mental  Alienation  "  ( Traite  sur  I' alienation  men- 
tale).  It  is  the  work  of  a  man  of  genius,  who  gave  to  the 
whole  science  of  psychiatry  a  new  direction,  and  was  a  century 
ahead  of  his  contemporaries.  And,  indeed,  Capo  dTstria  rec- 
ognized this  when  he  concluded  with  these  words :  "  For  the 
glory  of  Pinel,  it  is  enough  to  recall  the  fact  that  he  was  the 


98  PSYCHIC   TREATMENT 

promulgator  of  a  new  principle,  and,  in  the  language  of  modern 
terminology,  TUOS  the  first  to  introduce  psychotherapy  for  the 
treatment  of  mental  diseases." 

If  the  rebellious  character  of  many  of  the  insanities  often 
renders  this  treatment  of  the  mind  futile,  psychotherapy  is,  on 
the  other  hand,  most  powerful  when  it  has  to  do  with  the 
psychoses  of  lesser  degree  which  are  called  "  neurasthenia," 
"  hysteria,"  "  hypochondria,"  and  "  want  of  mental  balance." 
The  reason,  we  shall  see,  is  not  intact  in  these  comparatively 
mild  states,  but  the  patient  is  much  more  accessible  to  moral 
influence  than  the  insane.  Persuasion  by  logical  methods  is 
a  magic  wand  in  such  cases. 

All  that  Pinel  has  said  of  the  insane  is  true,  but  it  is  a 
hundred  times  more  true  with  regard  to  the  psychoneuroses. 
The  mental  trouble  here  seems  so  slight  that  the  public  refuses 
to  see  the  bond  which  connects  such  nervousness  with  the 
insanities.  The  physicians  themselves  do  not  always  recognize 
the  close  relationship.  On  the  other  hand,  I  have  shown  how 
slightly  these  psychopathies  differ  from  the  normal  condition, 
so  slightly  that  one  often  asks  one's  self  if  they  are  really 
diseases. 

In  the  presence  of  an  abnormal  mentality  it  is  not  wise  to 
have  recourse  solely  to  physical  or  medicinal  measures,  to  the 
douche  (which  is  often  used  at  random  in  psychiatry),  to 
various  narcotics  (which  have  taken  the  place  of  the  old- 
fashioned  hellebore),  or  to  brutal  constraint,  whether  physical 
or  moral.  We  must  come  back  to  the  educative  influence. 

It  is  an  easy  measure  to  employ ;  it  produces  quick  and  last- 
ing effects  beyond  all  expectation.  When  the  patient  has  be- 
come master  of  himself,  he  will  continue  his  education  after 
his  cure.  This  method  will  establish  his  moral  attitude,  and 
will  preclude  such  relapses  as  might  be  occasioned  by  emer- 
gencies in  his  psychical  or  physical  life. 

In  order  to  proceed  with  method  in  this,  the  only  rational 
line  of  therapeutics,  one  must  clearly  understand  the  nature  of 
nervousness,  and  the  causes  which  give  birth  to  it  or  keep  it 
alive.  One  must  analyze  the  symptoms,  go  back  to  their  ori- 
gin, distinguish  those  which  depend  more  or  less  upon  the  body, 


OF   NERVOUS    DISORDERS  99 

and  recognize  the  purely  psychical  character  of  others.  Only 
clear  views  on  this  subject  can  give  a  physician  assurance, 
establish  his  moral  prestige  in  the  eyes  of  his  patients,  and  give 
him  the  power  to  cure  them. 

How  far  we  are  from  this  ideal !  There  is  still  an  incredi- 
ble incoherence  of  ideas  among  physicians.  On  this  point  the 
patients,  or  their  near  friends,  can  often  see  more  clearly  than 
their  ^sculapius,  and  they  laugh  in  their  sleeves  at  the  treat- 
ments which  he  makes  the  patients  undergo. 

I  see  many  young  women  who  present  a  perfect  picture 
of  the  various  symptoms  of  nervousness — dyspeptic  troubles, 
general  weakness,  divers  pains,  insomnias,  and  phobias.  A 
quarter  of  an  hour  of  conversation  is  enough  to  recognize  the 
abnormal  mentality  of  one  of  these  subjects  and  her  exagger- 
ated impressionability,  which  one  can  often  trace  to  her  earliest 
infancy.  It  is  easy  to  detect  her  lack  of  logic  and  the  mental 
genesis  of  a  host  of  autosuggestions  which  rule  her.  This  natu- 
ral nervousness,  after  being  manifested  in  childhood  by  noc- 
turnal terrors  and  by  a  sickly  sentimentality,  is  aggravated  at 
the  period  of  puberty — that  time  when,  by  influences  which  are 
still  mysterious,  the  mentality  of  young  girls  often  undergoes 
a  complete  change.  If  married,  the  wife  does  not  find  in  the 
conjugal  union  the  happiness  of  which  she  had  dreamed;  if 
she  remains  an  old  maid,  she  suffers  in  silence  sharp  regrets 
which  arise  from  the  feeling  of  having  missed  something  in  life. 

It  is  not  always  real  misfortune  which  troubles  the  mind 
of  the  patient,  and,  as  a  consequence,  disturb  his  physical 
health ;  it  is  the  trifling  nothings,  the  petty  annoyances,  and  the 
pin-pricks  of  life.  A  little  philosophy,  which  is  easy  to  incul- 
cate, would  be  enough  to  reestablish  mental  equilibrium  and  to 
suppress  functional  disorders. 

But  no  one  ever  thinks  of  that.  A  celebrated  gynecologist, 
who,  however,  seems  to  still  be  wearing  the  blinders  of  the 
young  specialist,  discovers  an  hypertrophy  of  the  uterus,  a 
slight  ulceration  of  the  cervix,  a  little  inflammation  of  the 
uterus.  Behold  the  cause  of  all  the  trouble !  The  patient  may 
insist  in  vain  on  the  moral  causes  of  her  nervousness;  the 
operator  will  not  let  himself  be  thwarted;  he  amputates  and 


100  PSYCHIC   TREATMENT 

cauterizes,  performs  curettages  of  the  uterus,  and  expects  to 
see  the  nervous  symptoms  disappear.  He  deludes  himself  into 
thinking  that  he  has  obeyed  the  addage:  the  cause  being  re- 
moved the  effect  will  be  done  away  with  (sublata  causa  tollitur 
effectus).  But,  to  his  great  astonishment,  nothing  of  the  sort 
occurs. 

The  patient  falls  into  the  hands  of  a  specialist  in  the  treat- 
ment of  diseases  of  the  stomach.  This  latter  is  a  serious 
physician  who  is  not  content  with  a  superficial  examination. 
Just  think ;  he  syphons  the  stomach,  analyzes  the  gastric  juice, 
injects  air  into  the  organ,  and  notes  its  limits  with  a  blue 
pencil.  With  an  expert  hand  he  produces  succussion,  and  then 
declares :  "  You  have  a  dilatation  of  the  stomach,  with  hypo- 
acidity ;  you  will  never  be  well  as  long  as  the  motility  and  the 
chemistry  of  your  stomach  are  impaired !  "  He  prescribes  a 
bandage  to  support  the  sagging  stomach,  and  a  dry  diet,  and 
notes  carefully  what  foods  should  be  avoided.  He  makes  such 
a  long  list  of  them  that  he  would  have  lost  less  time  in  noting 
those  that  were  permitted. 

The  patient  grows  thinner  and  thinner,  and  becomes  weak. 
She  suffers,  it  is  true,  a  little  less  with  her  stomach  because  she 
does  not  demand  much  of  this  organ,  but  she  is  more  nervous 
than  ever. 

Electricity  is  the  next  thing  on  the  program.  The  patient 
sits  down  on  the  insulated  stool  of  the  static  machine.  The 
buzzing,  the  static  brush,  the  disruptive  discharges  are  all  going 
to  act  upon  her  neurons  as  upon  the  "  coherer  "  of  wireless 
telegraphy.  And  it  is  with  a  feeling  of  profound  content  that 
the  neurologist  runs  his  electrode  up  and  down  over  the  surface 
of  the  body,  without  allowing  himself  to  be  at  all  discon- 
certed by  the  smile — which  is  oh !  so  skeptical — of  the  patient. 
Frankly  of  the  two  it  is  difficult  to  decide  which  is  subject  to 
the  greater  vagary ! 

I  have  not  overdrawn  this  picture.  Moliere  would  have 
enjoyed  himself  hugely  to-day.  I  understand  these  thera- 
peutic vagaries  up  to  a  certain  point.  I  have  shown  that  it  is 
the  fruit  of  our  medical  education,  and  we  have  a  great  deal 
of  trouble  in  getting  out  of  the  beaten  track.  But  it  is  time 


OF  NERVOUS   DISORDERS          101 

for  this  to  change.  And,  while  continuing  to  use  for  the  good 
of  our  patients  the  physical  and  medicinal  measures  at  our  dis- 
posal, we  must  recognize  the  influence  of  the  mind;  we  must 
analyze  this  action,  and  learn  to  take  advantage  of  this  helpful 
measure,  which  has  been  too  long  neglected. 

The  specialist  in  neurology  and  psychiatry  is  not  the  only 
one  who  ought  to  sharpen  his  faculties  of  psychological  obser- 
vation and  resolutely  enter  the  path  of  psychotherapy.  The 
surgeon  ought  to  know  these  psychopathic  conditions  if  he 
wants  to  avoid  unfortunate  complications.  Have  we  not  seen 
them  remove  the  appendix  in  patients  seized  with  hysterical 
attacks  of  pain,  open  the  abdomen  of  a  confirmed  hypochon- 
driac to  prove  to  him  that  he  did  not  have  cancer,  perform  a 
gastroenterostomy  in  a  nervous  dyspeptic,  and  do  an  ovari- 
otomy on  an  hysterical  patient  ?  They  even  perform  operations 
to  cure  neurasthenic  patients  whose  mental  condition  is  dis- 
turbed by  morbid  introspection. 

And  in  the  numerous  specialties  whose  existence  is  justified 
by  the  fact  that  they  call  for  a  certain  operative  routine,  those 
of  the  oculist,  the  rhinologist,  and  laryngologist,  would  it  not 
be  better  to  operate  and  cauterize  and  scrape  less,  and  to  rec- 
ognize, even  in  those  ills  which  seem  so  localized,  the  enormous 
influence  of  unhealthy  autosuggestion  and  the  power  of  mental 
representations,  and  to  remember  those  diathetic  conditions 
which  often  render  local  therapy  illusive. 

In  conclusion,  the  practitioner  of  small  towns  and  country 
places,  who  must  give  to  everybody  at  least  the  first  help,  ought 
to  know  all  things,  and  can  not  afford  to  ignore  this  medicine 
of  the  mind.  He  knows  his  patients  better  than  the  city  man 
does  his  patrons.  He  is  acquainted  with  their  ordinary  mental 
condition  and  their  hereditary  influences ;  he  almost  lives  with 
them.  Naturally  he  lacks  the  time  to  deliver  long  psycho- 
therapic  conversations  to  them,  but  if  he  is  a  psychologist  he 
will  have  no  trouble  in  distinguishing  what  originates  in  the 
mind  and  what  is  only  physical. 

He  does  not  need  to  be  a  wizard  to  perceive  that  his  visit 
does  more  good  than  his  medicines.  He  will  see  that  all  the 
good  that  he  does  lies  in  showing  a  warm  sympathy  and  in  giv- 


102  PSYCHIC  TREATMENT 

ing  counsels  of  healthy  philosophy.  In  every  land  there  appear 
brochures  and  articles  in  the  papers,  showing  us  that  these 
truths  are  in  the  air,  and  that  a  new  avenue  is  opening  for 
medicine. 

Medical  teaching  of  the  twentieth  century,  without  neg- 
lecting the  conquests  of  the  preceding  one,  will  give  a  larger 
and  larger  place  to  rational  psychotherapy.  It  will  renounce 
the  puerilities  of  hypnotism  and  suggestion  in  order  to  arrive 
at  the  education  of  the  mind. 

With  men,  as  with  dolls,  the  heads  are  the  most  fragile: 
they  are  in  constant  need  of  repairs.  There  is  a  great  deal  to 
do  in  this  field,  and  the  physician  who  loves  his  art  will  under- 
take the  work  joyfully. 


OF  NERVOUS   DISORDERS          103 


CHAPTER   IX 

Psychic  Symptoms  of  Nervousness  —  Psychic  Origin  of  Functional 
Troubles  —  Every  Organic  Disease  Has  Its  Counterpart  in  Nervous- 
ness—The Characteristic  Thing  of  Nervous  Patients  is  Not  Their  Pains 
but  Their  Mentality  —  Mental  Stigmata:  Suggestibility,  Fatigability 
—  Exaggerated  Sensibility  and  Emotivity  —  Suggestion  and  Persua- 
sion— Suggestibility  in  a  Normal  State 

WHAT  symptoms,  then,  of  nervousness,  to  use  the  most 
general  term,  are  psychic  in  their  nature,  and  justify  my  oft- 
repeated  statements  that  psychic  treatment  is  necessary  for 
psychic  ills? 

If  one  considers  the  very  essence  of  the  phenomenon  of 
thought  every  distinction  between  the  spirit  and  the  body  dis- 
appears, for  it  is  understood  that  where  there  is  a  working  of 
the  mind  there  is  cerebral  vibration.  But  these  two  movements, 
so  intimately  associated  that  they  have  become  one,  may  be 
incited  along  the  lines  which  I  have  called  physiological  or 
somatic  through  the  medium  of  the  blood  or  of  the  sen- 
sory nerves;  they  may  also  give  rise,  by  the  psychological 
path,  to  mental  representations  which  come  to  be  interpo- 
lated into  the  reflex  arc.  In  short,  the  ultimate  expression 
of  the  reaction,  whether  the  latter  be  somatic  or  psychic  in 
origin,  may  itself  be  psychic,  in  that  it  is  expressed  by  thoughts 
and  by  more  or  less  conscious  volitions,  whether  or  not  it  arises 
as  a  bodily  manifestation  through  the  channel  of  the  emotions. 
It  is  in  this  double  point  of  view  of  the  origin  and  end  of  the 
reaction  that  the  distinction  between  the  moral  and  the  physical 
exists. 

The  neurasthenic  who  complains  chiefly  of  habitual  sad- 
ness and  chronic  ennui,  who  feels  growing  within  him  a  morbid 
sense  of  timidity  and  discouragement  and  an  increasing  misan- 
thropy, will  not  be  astonished  if  you  tell  him  that  these  are 
psychic  manifestations,  and  he  will  understand  how  much  it 


104  PSYCHIC   TREATMENT 

bears  upon  the  treatment  to  find  out  whether  this  sadness  is 
caused  by  a  diseased  condition  of  the  body  or  is  induced  by 
moral  suffering. 

Any  patient  who  does  not  sleep  regards  his  condition  as 
physical,  but  he  will  not  be  slow  to  recognize  the  psychic  origin 
of  insomnia  when  you  point  out  to  him  that  what  hinders  him 
from  sleeping  are  often  distressing  memories  and  worries  over 
the  future  or  the  apprehension  of  insomnia.  It  is  not  rare  to 
have  patients  state  that  a  headache  has  resulted  from  an  emo- 
tion, therefore  from  an  idea,  and  if  the  headache  proves  to  them 
that  some  material  process  has  taken  place  in  their  brain  they 
will  willingly  admit  that  this  trouble  has  psychological  causes, 
and  that  it  arises  from  another  source  than  that  of  the  headache 
succeeding  the  abuse  of  alcohol  or  the  inhalation  of  nitrite 
of  amyl. 

But  when  you  tell  a  nervous  dyspeptic  that  his  digestive 
troubles  are  psychic  in  their  origin,  or  a  paraplegic  hysterical 
patient  that  his  affection  is  psychic,  or  a  hypochondriac  that 
his  pain  is  also  psychic,  you  will  often  be  met  by  a  smile  of 
incredulity.  Your  patient  will  feel  that  you  abuse  this  word 
psychic.  You  will  often  detect  in  him  some  slight  sign  of 
temper,  such  as  a  sudden  coloring ;  he  will  be  vexed,  believing 
that  you  do  not  understand  him  and  that  you  think  his  ills 
imaginary. 

Yet,  nevertheless,  this  is  wholly  psychic;  clinical  analysis 
proves  it  more  and  more.  Nervous  symptoms  do  not  ordi- 
narily arise  in  somatic  ways  under  the  influence  of  purely 
physical  irritations,  as  do  the  unconscious  nervous  reflexes. 
We  find  everywhere  the  interpolation  of  these  so-called  psychic 
phenomena;  everywhere  the  idea  comes  in,  often  creating  the 
functional  trouble  out  of  whole  cloth,  and  sometimes,  if  it  has 
originally  occurred  under  the  influence  of  an  accidental  cause, 
of  a  traumatism  (for  example,  some  previous  bodily  illness  or 
intoxication),  the  idea  will  keep  it  alive  and  nurse  it  along 
forever. 

The  symptoms  of  psychoneuroses  are  legion.  Nearly  all 
the  clinical  syndromes  which  characterize  bodily  diseases  have 
their  counterpart  in  nervousness. 


OF   NERVOUS   DISORDERS          105 

Alongside  of  angina  pectoris  there  is  the  false  nervous 
angina;  one  can  detect  the  greater  number  of  cardiopathic 
symptoms  in  nervous  cardiac  troubles.  More  often,  from  the 
point  of  view  of  objective  symptoms,  such  as  the  condition  of 
the  tongue,  the  nature  of  the  gastric  juice,  and  disturbances  of 
the  motility  of  the  stomach,  nervous  dyspepsia  does  not  differ 
in  any  way  from  dyspepsia  of  organic  origin.  There  are  states 
of  nervous  anorexia,  with  vomiting,  emaciation,  and  fever, 
which  are  diagnosed  as  meningitis;  there  are  astasia-abasias, 
which  give  the  idea  of  a  cerebellar  neoplasm ;  there  are  visceral 
neuralgias,  which  lead  one  to  believe  that  there  is  tuberculous 
peritonitis,  and  often  occasion  the  wholly  futile  intervention 
of  the  surgeon.  We  often  even  mistake  articular  neuroses  and 
treat  them  as  local  affections,  when  the  painful  sensations  are 
purely  ideogenic. 

I  should  never  get  to  the  end  if  I  were  to  enumerate  all  the 
errors  of  diagnosis  which  result  from  the  imperfect  knowledge 
of  normal  and  morbid  psychology ;  it  would  necessitate  rewrit- 
ing the  dictionary  of  pathology  to  suit  the  neurologist  and 
psychiatrist.  That  which  characterizes  the  psychoneuroses  is 
not  the  various  symptoms,  the  innumerable  functional  troubles, 
resembling  those  of  organic  diseases  or  the  distressing  sensa- 
tions that  the  patient  may  experience;  it  is  his  state  of  mind, 
his  mentality. 

We  all  of  us  get  tired ;  but  we  know  what  it  is,  and  we  are 
assured  beforehand  that  a  little  rest  is  all  that  we  need.  The 
neurasthenic,  however,  is  frightened;  he  takes  his  weariness 
with  great  concern,  and  makes  it  last  longer  by  the  attention 
that  he  pays  to  himself.  The  human  mechanism  is  so  compli- 
cated that  hardly  a  day  goes  by  without  our  noticing  some 
creaking  in  the  works.  Sometimes  it  is  gastric  trouble,  or  a 
slight  pain  or  palpitation  of  the  heart,  or  a  transient  neuralgia. 
Full  of  confidence  in  our  comparative  health,  we  keep  right  on, 
making  light  of  these  little  ailments.  The  hypochondriac,  on 
the  other  hand,  is  fascinated  by  the  idea  of  sickness ;  it  becomes 
a  fixed  idea  with  him. 

We  all  have  to  endure  annoyances,  but  we  try  to  rise  above 
them  and  to  keep  our  good  humor.  The  neurasthenic  and  the 


106  PSYCHIC   TREATMENT 

hysterical  person  looks  at  everything  with  a  magnifying  glass ; 
the  slightest  event  becomes  a  catastrophe. 

Men  generally  fear  death,  but  its  specter  is  not  always 
before  their  eyes.  Often  they  forget  it  in  a  natural  careless- 
ness ;  often  they  look  upon  it  as  an  inevitable  but  remote  event ; 
they  are  not  inordinately  frightened  by  it.  The  nervously 
afflicted,  on  the  contrary,  are  often  possessed  by  this  idea  of 
final  dissolution,  and  suffer  for  years  in  terror  of  the  specter 
death. 

The  real  causes  of  the  psychoneuroses  are  not  in  the  acci- 
dental happenings  that  have  provoked  acute  symptoms,  such  as 
traumatism,  illness,  functional  disorder,  emotion,  and  fatigue. 
These  provocative  agents  act  on  us  every  day,  but  they  lead  to 
no  permanent  trouble  in  our  health,  because  we  resist  them  with 
a  more  or  less  voluntary  indifference.  The  nervous  patient, 
on  the  other  hand,  reacts  by  virtue  of  his  abnormal  mentality. 
One  finds  in  him  the  characteristic  mental  stigmata. 

These  stigmata  are  innumerable,  if  one  considers  the  va- 
rious forms  of  nervousness  and  the  association  of  ideas  which 
give  rise  to  the  phobias  and  foster  fatal  autosuggestions.  Each 
reacts  mentally  in  its  own  way. 

But  it  is  possible  to  trace  these  various  manifestations  to 
some  peculiarities  that  are  mentally  primordial.  For  I  notice, 
first  of  all,  in  nervous  patients  of  all  kinds,  a  marked  exagger- 
ation of  the  inherent  faults  of  human  nature.  Nervous  patients 
are  suggestible,  susceptible  to  fatigue,  sensitive,  and  emotional 
to  a  degree. 

One  might  say,  paradoxically  speaking,  that  they  are  not 
sick.  Not  one  of  them  presents  any  new  phenomenon  that  is 
unknown  in  a  healthy  man ;  there  is  no  intervention  of  special 
pathogenic  agents,  as  in  the  infectious  diseases,  and  no  alter- 
ation of  the  organs  determining  functional  troubles. 

In  such  patients  there  is  only  an  exaggeration  of  normal 
reactions  that  is  expressed,  not  only  by  the  intensity  of  the 
phenomena  and  the  facility  with  which  they  occur,  but  also  by 
deviation  from  the  primitive  type  of  the  reaction,  as  shown  in 
unexpected  vagaries.  I  hold  strongly  to  this  conception,  which 
makes  me  examine  the  normal  mentality  for  the  general  outline 


OF  NERVOUS    DISORDERS          107 

of  the  peculiarities  of  our  patient.  It  is  fertile  in  suggestions 
that  interpret  the  functional  disorders;  it  gives  us  the  most 
efficient  aid  in  therapeutic  treatment. 

An  exaggerated  suggestibility  is  one  of  the  characteristic 
stigmata.  It  is  common  to  neurasthenics  and  hysterical  per- 
sons ;  it  is  found  in  its  most  pronounced  forms  among  degener- 
ate and  unbalanced  people;  it  plays  an  important  role  in  the 
genesis  of  various  insanities. 

Some  find  that  this  word  "  suggestion  "  is  abused  to-day ; 
others,  on  the  contrary,  give  it  so  general  a  sense  that  they  do 
not  hesitate  to  say  there  is  nothing  but  suggestion  in  the  world, 
we  live  continually  under  the  sway  of  suggestions. 

The  only  thing  to  do  is  to  come  to  an  understanding  on  the 
value  of  the  term. 

In  its  primitive  acceptation,  to  suggest  means  to  make 
something  enter  the  mind,  and  as,  in  short,  our  whole  mental 
life  is  carried  on  by  ideas  that  have  penetrated  our  under- 
standing, we  could  say  that  suggestibility  is  the  highest  quality 
of  the  human  mind  and  the  absolute  condition  of  all  intellectual 
or  moral  perfection. 

But  the  dictionaries  teach  us  that  the  words  "  suggest  "  and 
"  suggestion  "  are  used  with  a  sinister  meaning. 

We  do  not  speak  of  suggestion  when,  by  honest  persuasion 
and  a  logical  setting  forth  of  good  reasons,  we  have  influenced 
the  conviction  of  our  neighbor,  when  we  have  led  him  to  a 
determination  which  he  will  have  no  cause  to  regret. 

Suggestion  does  not  come  into  the  domain  of  exact  sciences 
or  mathematics ;  here  one  does  not  suggest,  one  proves. 

Suggestion  implies  that  good  faith  has  been  more  or  less 
imposed  upon ;  that,  by  using  the  subterfuges  of  a  facile  logic, 
one  has  gotten  around  the  subject,  and  led  him  to  views  which 
he  would  not  have  admitted  if  he  had  followed  the  counsels  of 
reason  and  his  own  good  sense.  To  suggest  a  last  will  and 
testament  implies  the  use  of  artifice  or  dishonest  insinuation 
in  its  making.  One  speaks  again  of  suggestion  when  our 
conduct  is  determined  by  some  mental  caprice.  Marmontel 
has  written :  "  It  was  ambition  which  suggested  to  him  this 
rash  measure." 


108  PSYCHIC  TREATMENT 

However,  in  the  last  few  years  the  word  has  taken  unto 
itself  a  less  perplexing  acceptation.  One  says  of  a  book  which 
makes  one  think :  "  It  was  a  very  suggestive  work."  One 
could  also  say :  "  It  was  goodness  which  suggested  to  that 
man  such  an  act  of  devotion." 

Thus  understood,  the  word  "  suggestibility  "  indicates  that 
faculty  of  mind  which  permits  any  one  to  be  persuaded,  by  no 
matter  what  process,  of  the  existence  of  a  fact,  of  the  justice 
of  an  idea,  or  of  the  excellence  of  a  determination.  But  there 
is  interest  in  differentiating  and  even  contrasting  the  terms 
"  persuasion "  and  "  suggestion."  Bechterew  has  cleverly 
noted  the  difference  in  saying  that  suggestion  enters  into  the 
understanding  by  the  back  stairs,  while  logical  persuasion 
knocks  at  the  front  door. 

If  the  healthy  man  knew  enough  to  obey  only  pure  reason 
or  just  sentiments,  and  if  only  the  sick  man  were  weak  enough 
to  become  the  plaything  of  illusions,  the  distinction  would  be 
easy  and  one  could  say :  "  The  men  of  sound  mind  let  them- 
selves be  persuaded;  only  sick  people  are  suggestible." 

But  in  speaking  thus  the  king  of  creation  would  manifest 
quite  too  good  an  opinion  of  himself.  In  spite  of  civilization, 
in  spite  of  the  enormous  efforts  of  science,  we  are  still  very 
weak,  and  we  all  suffer  from  a  most  lamentable  suggestibility 
in  the  most  unfavorable  sense  of  the  word. 

As  soon  as  we  leave  the  firm  ground  of  mathematical  rea- 
soning we  experience  an  incredible  difficulty  in  resisting  sug- 
gestion. When  we  formulate  an  opinion,  or  when  we  allow 
ourselves  to  be  persuaded,  it  is  very  rare  that  logic  is  the  only 
cause.  Affection,  esteem,  the  fear  which  those  who  are  talk- 
ing to  us  inspire  in  us  surreptitiously  prepare  the  paths  of  our 
understanding,  and  our  reason  is  often  taken  in  a  trap.  Our 
sensibility  intervenes,  our  feelings  and  our  secret  desires  mingle 
with  the  cold  conception  of  reason,  and,  without  being  con- 
scious of  it,  we  are  led  into  error.  We  let  ourselves  be  capti- 
vated by  a  superficial  eloquence,  by  the  charm  of  language, 
and  we  yield  at  the  first  beck  of  attraction.  In  all  domains 
of  thought,  even  when  we  believe  that  we  are  enjoying  the 
most  complete  independence  of  mind,  we  are  submitting  to  the 


OF  NERVOUS   DISORDERS          109 

yoke  of  ancient  ideas  which  we  have  repudiated  in  Our  logical 
moments,  but  which  have  left  their  ineffaceable  stamp  upon 
our  mind. 

In  politics  and  in  philosophy  we  are  almost  incapable  of 
effacing  the  influence  of  education.  Even  when  there  is  estab- 
lished between  certain  men  a  community  of  aspiration  and 
ideas,  one  may  still  find  in  each  one  of  them  a  mentality  that 
is  Catholic,  Protestant,  Jewish,  etc.,  and  it  would  be  well  if  that 
which  thus  binds  us  to  the  family,  to  the  country,  or  to  the 
race,  were  always  a  healthy  sympathy  of  which  reason  could 
approve.  But  how  often  do  we  find  lack  of  judgment  at  the 
base  of  this  dogmatism!  How  often  do  we  feel  that  we  are 
obeying  in  a  spirit  of  contradiction  and  prejudice  when  we 
ought  to  follow  reason!  Fatigue,  sickness,  and  age  render 
more  difficult  the  mental  processes  constituting  reflection,  and 
we  give  ourselves  up,  as  captives  bound  hand  and  foot,  to 
suggestive  influences  which,  at  another  time,  we  should  have 
rejected.  Thus,  mental  states  are  contagious  in  the  narrow 
circle  of  the  family,  in  a  social  class,  and  in  a  people.  Just 
as  in  the  middle  ages  there  arose  epidemics  of  hysteria,  we 
also  have  proof  of  collective  mental  troubles  in  different  coun- 
tries. It  seems  sometimes  that  a  country,  in  part  or  as  a 
whole,  has  lost  its  judgment;  that  a  wind  of  folly  has  blown 
over  the  land.  During  a  certain  time  it  is  this  country  or  that 
race  which  seems  to  show  symptoms  of  pathological  suggesti- 
bility ;  to-morrow  the  strong,  who  were  yesterday  proclaiming 
with  a  disdainful  smile  the  lack  of  balance  in  their  neighbor, 
will  in  their  turn  lose  their  heads,  thus  illustrating  the  weakness 
of  the  human  mind. 

A  man  pretends  to  be  an  intelligent  being,  and  fears  noth- 
ing so  much  as  a  reproach  of  folly.  Nevertheless,  if  he  wants 
frankly  to  examine  his  conscience  he  will  find  that  it  is  difficult 
always  to  see  clearly,  and  that  daily  he  is  the  victim  of  un- 
reasonable suggestions.  Our  judgment  is  subject  to  continual 
eclipses. 

Sometimes  this  suspension  of  reasonable  control  is  volun- 
tary, because  in  a  certain  event  we  do  not  feel  the  need  of  pro- 
tecting ourselves  by  consistent  reasonableness.  It  is  in  this 


110  PSYCHIC   TREATMENT 

way  that  we  easily  become  the  victims  of  illusions  when  we 
allow  ourselves  to  be  guided  by  a  single  sense.  If  we  see,  in 
a  place  where  we  might  naturally  suppose  it  possible  for  a  cat 
to  be,  a  gray  mass  about  the  size  of  that  animal,  we  do  not 
often  take  the  trouble  to  test  this  perception,  and  we  affirm  the 
existence  of  the  cat  with  a  conviction  which  would  draw  other 
persons  into  our  error.  Under  the  sway  of  distraction,  we 
often  arrive  at  such  summary  judgments.  It  is  thus  by  the 
mechanism  of  a  hasty  conclusion  that  we  allow  ourselves  to 
be  led  into  sensorial  illusions.  Everybody  can  find  in  his  own 
memory  examples  of  this  suggestibility,  and  see  that  he  could 
have  escaped  the  illusion  if  he  had  kept  better  control  of  his 
attention  and  brought  his  reason  into  play. 

Error  by  autosuggestion  is  greatly  facilitated  by  the  fact 
that  a  mental  representation  is  already  a  sensation.  The  prin- 
ciple of  concomitance  demands  it;  there  is  a  cerebral  state 
corresponding  to  every  idea,  whether  it  be  born  by  virtue  of 
a  true  sensorial  impression,  or  whether  it  be  a  purely  mental 
representation,  the  same  sensation  ought  to  correspond  to  the 
same  cerebral  condition.  When  the  testimony  of  a  sense  !s 
too  quickly  accepted  a  suggested  sensation  accompanies  it;  it 
encourages  us  in  our  error,  and  fixes  it. 

The  wine  which  we  pour  out  of  a  dusky  bottle  bearing  the 
label  of  a  celebrated  vineyard  always  seems  better  than  it 
really  is;  a  connoisseur  among  smokers  will  let  his  judgment 
be  influenced  if  he  recognizes  the  make  of  the  cigar  that  he  is 
smoking.  Certain  people  experience  a  sensation  of  touching 
oil  and  the  smell  of  petroleum  in  taking  up  a  lamp  which  has 
never  held  any.  The  majority  of  people  feel  various  sensa- 
tions in  touching  the  pole  of  an  electric  apparatus  when  it  fur- 
nishes neither  currents  nor  discharges. 

At  my  advice,  Dr.  Schnyder,  of  Bern,  has  studied  this 
suggestibility  in  my  patients.  Instructed  to  note  the  condition 
of  tactile  and  painful  sensibility,  to  experiment  upon  the  cuta- 
neous and  tendinous  reflexes,  he  ended  with  a  so-called  test 
of  electric  sensibility.  The  posts  of  a  hand  rheostat  which 
contained  no  source  of  electricity  were  fastened  to  two  wires 
terminated  by  rings  which  were  put  upon  the  fingers  of  the 


OF   NERVOUS   DISORDERS          111 

patients.  Avoiding  all  other  suggestion,  the  observer  begged 
the  subjects  on  whom  he  was  experimenting  to  tell  him  simply 
just  what  they  felt.  The  illusion  of  an  electric  current  which 
one  could  make  stronger  or  weaker  was  strengthened  by  ma- 
nipulating the  rheostat,  by  sliding  it  onto  the  various  contact 
buttons.  More  than  two-thirds  of  the  patients  complained  of 
various  sensations  of  pricking,  warmth,  or  burning,  and  took 
pleasure  in  describing  them  minutely. 

Hack  Tuke  1  has  quoted  many  of  these  illusions  born  of  a 
hasty  conclusion  and  strengthened  by  the  autosuggestion  giving 
rise  to  the  sensation.  I  will  quote  some  personal  examples. 
It  has  happened  to  me  several  times,  on  entering  the  homes  of 
my  patients,  that  I  perceived  heat  radiating  from  a  stove  which 
I  believed  to  be  lighted.  This  hasty  conclusion  was  suggested 
by  the  coolness  of  the  air  which  made  me  suppose  that  they 
would  have  lighted  it.  I  was  quite  astonished  when  I  proved 
by  touching  it  that  I  was  deceived. 

One  of  my  friends  went  into  the  barber's  in  winter,  and  put 
his  chilled  feet  on  one  of  those  ornamented  brass  rests  with 
which  every  one  is  familiar.  Immediately  he  felt  a  gentle 
warmth  steal  over  his  feet,  and  said  to  himself :  "  Now  that 
is  a  practical  idea;  you  can  put  your  feet  up  and  get  them 
warmed  at  the  same  time !  "  He  could  not  believe  his  senses 
when  the  absence  of  all  heating  apparatus  was  proved  to  him. 

Question  eye-witnesses  concerning  the  details  of  some  event 
at  which  they  were  present,  and  you  will  see  that  they  have 
all  seen  differently  because  they  have  all  looked  through  the 
spectacles  of  their  understanding,  distorted  by  preconceived 
opinions  and  autosuggestions.  Judges  and  lawyers  know  how 
little  credence  they  often  can  give  to  the  declarations  of  even 
disinterested  witnesses. 

It  would  be  of  interest  to  collect  examples  of  these  illusions 
and  to  analyze  their  origin  with  care,  but  the  task  is  not  as 
easy  as  it  seems.  Even  in  such  scientific  analysis  we  have  to 
avoid  autosuggestions,  as  in  the  analysis  of  dreams  which  we 
try  to  remember,  and  which  we  embellish  at  the  same  time. 


1  Le  corps  ei  fesprit,  trad.    Parent,  1886. 


112  PSYCHIC   TREATMENT 

The  fairy  of  autosuggestion  slips  in  everywhere  with  her 
magic  wand. 

In  the  scientific  domain  we  always  try  to  make  experiments 
under  careful  control.  We  have  recourse  to  the  testimony  of 
the  different  senses,  we  submit  the  facts  to  the  control  of  several 
people,  we  repeat  the  experiment,  and,  even  in  hypotheses,  we 
try  to  be  logical.  Thus,  people  whose  scientific  intellect  is 
developed  are  less  naturally  suggestible. 

But  even  in  this  domain  it  is  impossible  to  avoid  error.  I  am 
not  speaking  now  of  those  scholars  who,  tho  often  illustrious, 
are  sometimes  slightly  unbalanced,  who  can  show  superior  logic 
in  mathematical  work,  and  yet  who  let  themselves  be  caught  in 
the  net  of  the  gross  superstitions  of  spiritualism  and  telepathy. 
Even  those  who  escape  these  weaknesses  are  subject  to  error, 
and  often  confound  their  desire  with  realities  and  their  sugges- 
tions for  facts.  There  is  no  human  brain  capable  of  completely 
resisting  illusions  and  of  allowing  reason  supreme  control. 

If  autosuggestion  is  capable  of  leading  us  into  error  con- 
cerning even  the  existence  of  a  fact,  and  capable  of  giving  rise 
to  a  purely  suggested  sensation,  it  is  still  more  powerful  when 
we  enter  the  world  of  internal  sensations,  sentiments,  or  convic- 
tions. Here  we  no  longer  have  the  question  of  the  possibility 
of  control  by  our  five  senses ;  we  have  to  do  with  vague  sensa- 
tions and  mental  views  which  have  no  objective  reality. 

The  sensations  of  hunger,  thirst,  and  the  needs  of  mictu- 
rition and  defecation,  the  sexual  appetites,  and  the  general 
feeling  of  being  well  or  of  being  sick  occur  still  more  easily 
under  the  influence  of  a  purely  mental  representation  than 
under  the  localized  sensations  of  touch,  pain,  heat,  or  cold,  or 
the  perceptions  which  are  so  exact  as  those  of  sight,  hearing, 
taste,  or  smell.  To  those  who  doubt  the  influence  of  an  idea 
on  the  sensations  and  on  the  workings  of  the  various  physio- 
logical apparatus,  I  recommend  a  few'  moments'  reflection  on 
the  facts  of  the  sexual  life  in  old  age  and  in  dreams.  Listen  to 
Montaigne :  "  And.  burning  youth  flames  up,  so  impatient  in 
his  ardor  that  while  asleep  he  gratifies  his  amorous  desires  in 
dreams." 

This  suggestibility  becomes  extreme  when  our  convictions 


OF   NERVOUS   DISORDERS          113 

seek  to  become  established  in  strange  and  unknown  realms. 
Ignorance  renders  us  more  suggestible,  but,  whatever  our  cul- 
ture may  be,  we  do  not  escape  this  failing,  for  our  intelligence 
is  always  fragmentary,  we  are  always  ignorant  of  something. 

Modern  science  has  a  slightly  exaggerated  predilection  for 
the  experimental  method,  and  suggestibility  to-day  is  studied 
by  scientific  processes.1  One  makes  experiments  by  avoiding 
all  voluntary  suggestions  and  letting  the  subject  fall  naturally 
into  the  trap  without  pushing  him  into  it.  The  dominant  idea 
which  has  encouraged  the  error  is  then  analyzed,  and  thus  is 
detected  the  mechanism  of  suggestion.  In  this  way  one  suc- 
ceeds, without  hypnosis,  in  fixing  the  coefficient  of  suggesti- 
bility of  the  individuals  under  experiment,  in  determining 
their  reaction  under  moral  influence,  and  their  tendencies  to 
imitation. 

These  interesting  researches  ought  to  be  followed  up  more 
completely.  They  teach  us  to  know  the  defects  of  our  minds, 
and,  in  consequence,  to  overcome  them.  We  can  hold  ourselves 
back  better  if  we  see  the  declivity  down  which  we  are  on  the 
point  of  sliding. 

But,  without  awaiting  the  results  of  psychological  labors, 
and  limiting  ourselves  to  the  analysis  of  our  mentality  by  intro- 
spection, we  can  recognize  the  following  truths : 

Human  suggestibility  is  incommensurable.  It  enters  into 
<;very  act  of  life,  colors  all  our  sensations  with  the  most  varied 
lints,  leads  our  judgment  astray,  and  creates  those  continual 
illusions  against  which  we  have  so  much  trouble  to  defend 
ourselves,  even  when  we  exert  all  the  strength  of  our  reason. 

The  power  of  an  idea  is  such  that,  not  only  does  it  distort 
a  preexisting  sensation  or  an  idea,  but  it  can  create  the  sensa- 
tion in  its  entirety.  There  is  no  difference  for  the  individual 
who  feels  it  between  a  pain  provoked  by  a  peripheral  sensation 
and  that  which  results  from  a  simple  mental  representation — 
between  the  real  pain  and  the  imaginary  pain.  More  often  the 
patient  does  not  possess  any  criterion  by  which  to  decide  the 
question,  and  the  physician  himself  is  frequently  puzzled  over 


1  La  suggestibility.    Par  Alfred  Binet.    Paris,  1900. 


114  PSYCHIC   TREATMENT 

its  settlement.  He  can,  nevertheless,  come  to  some  conclusion 
by  making  an  analysis  of  the  mental  genesis  of  the  representa- 
tion— in  showing,  for  example,  the  inadequacy  of  the  trau- 
matism  which  has  provoked  the  pain  and  the  autosuggestions 
which  are  aroused  in  the  mind  of  the  patient.  The  demonstra- 
tion is  at  last  completed  by  the  rapid  disappearance  of  the 
trouble  under  the  influence  of  some  suggestion.  Then  the  sick 
man  himself  sees  clearly  and  recognizes  the  illusion  of  which  he 
has  been  the  victim  often  for  long  years.  There  are  patients 
who  have  themselves  reached  this  same  conclusion;  there  are 
those  who  at  the  first  consultation  tell  you :  "  The  moment  I 
am  told  about  any  sickness  of  which  I  am  afraid  I  immediately 
feel  the  symptoms."  The  physician  ought  to  remember  that  if 
exact  sensations  habitually  transmitted  by  our  five  senses  can 
be  born  through  autosuggestion,  the  mental  representation  acts 
still  more  powerfully  on  those  vaguer  sensations  which  have 
been  termed  cravings  for  action  or  inaction,  functional  sensa- 
tions, ccenesthesias,  emotional  sensations,  and  sensations  of 
pain  and  of  pleasure.1 

I  have  shown  that  one  must  distinguish  between  suggestion, 
which  acts  by  the  circuitous  paths  of  insinuation,  and  persua- 
sion, which  honestly  appeals  to  the  reason  of  the  subject. 
However  useful  the  final  result  may  be,  the  mental  mechanism 
has  been  distorted  by  the  suggestion,  and  the  determination 
is  more  or  less  abnormal.  What  is  more  absurd  than  to  fall 
asleep  by  daylight,  when  one  has  no  need  of  sleep,  by  stupidly 
yielding  to  the  command  of  the  hyponotizer?  Must  not  one  be 
credulous  in  order  to  have  one's  arms  held  up  in  the  air  or  to 
keep  one's  eyelids  shut  because  a  magician  has  told  you  that 
you  can  not  lower  your  arms  and  that  you  can  not  raise  your 
eyelids?  It  cruelly  abuses  the  mental  weakness  of  the  subject 
to  make  such  suggestions  to  him. 

Thus,  suggestibility  shows  in  general  a  lack  of  judgment, 
and  I  have  heard  hypnotizers  tell  me :  "  We  shall  easil;  get 
control  of  this  man ;  his  brain  is  debilitated  by  alcohol ;  he 
offer  less  resistance  to  suggestion." 


'  Let  sensations  internes,    Tar  Beaunis.    Felix  Alcan,  Paris,  1889. 


OF   NERVOUS    DISORDERS          115 

It  is  also  to  hasty  conclusions,  a  sign  of  mental  weakness, 
that  we  owe  the  majority  of  our  illusions. 

But  the  rule  is  by  no  means  general,  and  even  when  the 
subject  is  led  by  suggestion  to  a  reaction  that  is  absurd  in  its 
essence  it  might  have  also  followed  that  he  could  have  reached 
the  same  point  by  rational  ways. 

Here  is  a  workman  afflicted  with  rheumatism  which  has 
resisted  all  treatment.  He  is  discouraged,  and  has  only  one 
desire — to  be  cured  and  to  get  back  to  his  work.  They  propose 
hypnotism  to  him.  "  I  am  willing,"  replies  the  patient ;  "  I 
don't  know  what  it  is,  but  my  comrades  have  told  me  that  it 
does  good !  "  And  he  falls  asleep  the  moment  that  the  doctor 
has  pronounced  the  sacramental  words :  "  Sleep,  sleep,  sleep !  " 
Well,  here  we  have  a  man  of  good  sense  who  is  absolutely 
reasonable  in  his  incredible  suggestibility!  He  has  no  reason 
to  suppose  that  they  are  deceiving  him,  nor  has  he  any  reason 
to  doubt  the  encouraging  reports  of  his  comrades.  Ignorant 
of  medical  things,  and  making  no  pretense  to  have  any  knowl- 
edge of  them,  he  is  in  a  normal  state  of  mind,  in  the  favor- 
able psychological  position  to  accept  suggestion.  His  error  is 
excusable. 

It  is  the  same  way  with  the  young  soldier  whose  arm  was 
suddenly  paralyzed  by  a  suggestion.  He  had  entered  the  hos- 
pital for  treatment  for  angina,  and  the  professor  who  examined 
him  suddenly  flung  this  question  at  him :  "  How  long  is  it 
since  your  right  arm  was  paralyzed?" 

Astonished,  he  timidly  protested,  and  asserted  that  there 
was  nothing  the  matter  with  his  arm.  But  the  professor  did 
not  lose  his  assurance,  and,  addressing  himself  to  the  assem- 
blage of  students,  said :  "  You  see,  gentlemen,  here  is  a  young 
man  who  has  a  psychic  paralysis  of  the  right  arm,  and,  as  is 
generally  the  case  in  this  curious  disease,  the  subject  has  no 
knowledge  of  his  helplessness.  But,  nevertheless,  you  will 
admit  his  arm  is  inert,  and  when  I  let  go  of  it  after  having 
raised  it  up  it  falls  like  a  dead  weight !  "  And  the  arm  re- 
mained paralyzed  until  the  day  when  an  opposite  suggestion 
restored  the  use  of  it  to  the  young  man. 

"  What  a  stupid  that  young  soldier  must  have  been !  "  doubt- 


116  PSYCHIC   TREATMENT 

ers  will  say.  Not  at  all.  His  mental  state  was  quite  natural. 
Doubtless  he  could  have  thought :  "  Why,  no ;  my  arm  was  not 
paralyzed  when  I  came;  I  saluted  with  my  right  hand;  I  did 
such  and  such  work  before  coming." 

But  he  is  a  timid  young  peasant  who  has  lost  his  nerve  in 
the  presence  of  these  wise  gentlemen.  He  knew  nothing  of 
suggestion,  either  as  a  word  or  as  a  thing ;  he  could  not  grasp 
the  idea  of  a  practical  joke.  The  only  thing  left  for  him  was 
to  admit  that  these  wise  men  knew  more  about  it  than  he  did ; 
he  believed  it,  and  he  was  paralyzed.  The  error  was  absurd, 
but  it  is  inevitable  in  the  psychological  conditions  of  the  experi- 
ment. Credulity  is  here  the  fruit  of  ignorance  and  emotions 
which  are  quite  pardonable. 

It  is  none  the  less  true  that  suggestibility  is  only  a  de/ect, 
and  that  the  individual  who  wishes  to  preserve  the  integrity  of 
his  good  sense  and  to  assure  his  mental  health  ought  at  every 
turn  to  appeal  to  his  reason  and  keep  watch  over  his  mentality. 
He  will  perhaps  lose  the  slight  advantage  of  some  day  being 
able  to  be  cured  by  hypnotic  methods,  but  he  will  gain  the 
ability  to  escape  from  his  numerous  false  autosuggestions ;  for 
we  know  that  it  is  better  to  prevent  diseases  than  to  cure  them. 

A  critical  spirit  is  by  far  the  best  preservative  against  the 
numerous  functional  troubles  which  are  called  forth  by  means 
of  mental  representations.  It  is  our  moral  stamina  which  gives 
us  strength  to  resist  these  debilitating  influences. 

The  labors  of  hypnotizing  physicians  show  unmistakably  the 
incredible  suggestibility  of  the  human  being.  In  the  hypnotic 
state  we  can  turn  a  person  into  a  veritable  automaton,  make 
him  accept  suggestions  of  changed  identity,  double  his  person- 
ality at  will,  suggest  to  him  that  he  is  king,  make  him  shrink 
back  in  fright  before  an  imaginary  lion.  It  is  not  even  neces- 
sary to  resort  to  hypnosis  in  order  to  obtain  this  passive  obe- 
dience; a  verbal  suggestion  is  enough  in  the  waking  state. 
Hypnosis  is  nothing  in  itself;  it  is  itself  suggested  in  the 
waking  state,  and  more  frequently  than  not  there  is  no  use  in 
making  the  patient  pass  into  this  state  of  semisleep  or  artificial 
somnambulism. 

These  facts  are  true;  it  is  easy  to  be  convinced  of  it  in 


OF   NERVOUS   DISORDERS          117 

following  the  experiments  of  expert  physicians  in  this  matter. 
I  am  also  astonished  to  note  how  many  physicians  are  still  in  the 
greatest  ignorance  on  these  subjects.  Many  have  not  taken  the 
trouble  to  see  or  to  think,  and  still  believe  that  hypnosis  is  a 
pathological  condition  provoked  by  somatic  processes  acting 
directly  by  means  of  the  nerves  or  the  blood-vessels.  They 
forget  that  hypnosis  is  only  suggestion,  and  that  the  most  com- 
plete automatism  may  be  obtained  without  preliminary  sleep. 

The  demonstrations  of  physicians  are,  perhaps,  not  so  deci- 
sive because  they  obtain  the  most  curious  results  only  on  such 
subjects  as  have  already  been  hypnotized,  on  hysterical  patients, 
or  on  the  poor  alcoholic  wretches  which  we  hesitate  to  recog- 
nize as  our  fellows  from  the  mental  point  of  view. 

The  experience  of  wandering  hypnotizers  and  suggesters 
are  often  more  instructive.  They  clearly  show  the  passivity 
of  the  human  being  in  the  presence  of  heterosuggestions,  the 
rapidity  with  which  these  latter  become  autosuggestions,  and 
the  facility  with  which  the  mental  representation  is  transformed 
into  sensation  and  action. 

From  this  point  of  view  I  have  found  of  particular  interest 
the  demonstrations  of  a  German,  M.  Krause,  who  styles  himself 
"  Suggestor,"  and  has  given  seances  in  different  towns  of 
Germany  and  Switzerland.  He  made  his  debut  some  eighteen 
years  ago  as  a  hypnotist;  since  then,  probably  to  escape  the 
intervention  of  the  police,  he  has  limited  himself  to  verbal 
suggestion  in  the  waking  state. 

After  having  a  very  plain  talk,  in  which  he  defines  "  sug- 
gestion "  to  his  audience,  he  begins  his  experiments  on  a  dozen 
young  people  who  are  on  the  stage.  He  speaks  to  one  of  them, 
and  tells  him  to  throw  his  head  far  back,  to  open  his  mouth 
wide,  and  to  shut  his  eyes.  Then  in  a  low  voice  he  insinuates : 
"  You  can  not  open  your  eyes !  " 

The  subject  opens  them  without  any  difficulty,  shuts  his 
mouth,  and  resumes  a  normal  position ;  the  experimenter  sends 
him  back  into  the  hall  as  a  refractory  subject. 

The  same  performance  occurs  with  the  second  subject,  who 
also  opens  his  eyes,  smiling.  The  third  obeys  no  better,  and 


118  PSYCHIC   TREATMENT 

the  public  begins  to  believe  that  the  experiments  are  not  going 
to  succeed. 

But  M.  Krause  is  not  at  all  disturbed,  and  says,  calmly: 
"  Yes,  you  succeeded  in  opening  your  eyes  very  well,  but  did 
you  not  have  some  trouble?  It  wasn't  quite  as  easy  as  in  the 
normal  state  ?  " 

"  Yes,  I  did  have  a  little  difficulty,"  stammers  the  young 
man,  doubting  himself. 

From  this  moment  on  nearly  all  the  subjects  in  the  experi- 
ments are  under  the  charm,  and  proceed  to  obey  the  most 
absurd  suggestions. 

The  fourth  subject  the  experimenter  handles  without  gloves. 
He  places  him  on  a  chair  and  bends  him  over  backward,  he 
throws  his  head  sharply  back,  opens  his  jaws,  closes  his  eyes 
with  his  hand;  then,  in  a  tone  of  conviction,  he  says  to  him: 
"  You  can  no  longer  open  your  eyes,  nor  close  your  mouth, 
nor  even  pronounce  your  own  name.  Try ;  you  can  not  do  it !  " 
And  lo!  and  behold,  our  astounded  young  man  stays  in  this 
position,  exposed  to  the  ridicule  of  the  public.  How  is  he 
going  to  be  delivered  ?  That  is  very  simple.  M.  Krause  orders 
a  neighbor  to  put  his  hand  on  the  breast  of  the  subject  and  to 
count  "  One,  two,  three !  "  And,  sure  enough,  at  three  the 
patient  under  suggestion  opens  his  eyes  and  behaves  like  any 
normal  person. 

Why  this  passive  obedience?  Because  the  subject  has  be- 
lieved what  was  told  him.  Frightened,  disturbed,  and  plunged 
into  a  state  of  expectant  anxiety,  he  has  admitted  the  sugges- 
tion, and  the  representation  of  powerlessness  has  been  followed 
by  a  true  lack  of  power. 

After  this  first  success  has  been  obtained  M.  Krause  pro- 
ceeds rapidly  and  surely.  He  leans  one  of  his  subjects  against 
a  column  and  suggests  to  him  that  he  can  not  get  away  from 
it,  and  now  the  man  makes  vain  efforts  to  free  himself.  Cata- 
lepsy of  the  arms  and  legs  is  immediately  obtained  in  the 
majority  of  subjects  in  the  waking  condition.  Soon  the  assur- 
ance of  the  experimenter  knows  no  bounds.  Without  verbally 
suggesting  a  preliminary  sleep,  he  makes  his  subjects  accept 
the  most  absurd  suggestions.  He  doubles  their  personality, 


OF  NERVOUS   DISORDERS          119 

transforms  them  into  other  persons,  sends  them  to  purloin 
watches  from  the  audience,  then,  plunging  the  subject  back 
into  the  representation  of  his  moral  personality,  he  allows  us 
to  see  the  astonishment  of  these  young  men  who  are  completely 
bewildered  by  the  actions  which  they  have  committed  in  this 
secondary  state.  This  secondary  state,  observed  often  without 
suggestion  from  outer  sources  in  hysterical  people,  is  purely 
imaginary ;  it  is  only  the  result  of  an  accepted  suggestion ;  it  is 
due  to  nothing  but  the  incredible  credulity  of  the  subject. 

Now,  ninety  per  cent,  of  people  are  suggestible  on  this  point, 
and  theoretically  we  are  all  so  as  long  as  we  are  ignorant  of  the 
subject.  Nobody  is  absolutely  refractory  to  suggestion.  All 
depends  on  the  psychological  moment  in  which  we  find  our- 
selves, and  the  personality  of  the  suggester  counts  but  slightly 
in  the  success.  It  is  enough  for  him  to  be  a  psychologist  and 
to  have  audacity. 

Education  ought  to  undertake  the  task  of  delivering  us  from 
such  imbecile  suggestibility.  Reason  is  the  sieve  which  stops 
unhealthy  suggestions,  and  allows  only  those  to  pass  which 
lead  us  in  the  way  of  truth. 


120  PSYCHIC  TREATMENT. 


CHAPTER  X 

Fatigability —  Muscular  Fatigue;  Its  Location  —  Mental  Troubles  Con- 
nected with  Muscular  Fatigue ;  Ussier,  Fere  —  Psychic  Element  of 
Fatigue  —  Conviction  of  Fatigue  —  Cerebral  Fatigue  —  Ergographic 
Curves  —  True  Fatigue  and  Ordinary  Fatigue — Dynamogeny  and 
Dynamophany —  Importance  of  these  Ideas  to  the  Physician  and 
the  Educator 

I  HAVE  indicated  among  the  mental  stigmata  of  the  neu- 
roses exaggerated  fatigability.  The  word,  I  believe,  is  not 
in  the  dictionary,  but  it  deserves  a  place  there  because  it 
expresses  exactly  what  it  means.  This  fatigability  is  only 
diseased  when  it  is  exaggerated,  for  every  organ  that  function- 
ates will  tire.  Activity  in  no  matter  what  domain  supposes  the 
use  of  materials,  combustion,  disorganization  of  the  cell,  and 
accumulation  of  the  products  of  combustion.  Work  ought  to 
be  followed  by  rest,  which  allows  the  cell  to  recuperate  its 
used-up  strength  and  to  recover  its  normal  structure. 

The  phenomenon  of  fatigue  is  more  complex  than  it  seems 
at  first  glance,  and  we  are  still  in  ignorance  of  its  real  nature 
and  of  its  seat. 

I  raise  a  weight  a  great  many  times,  and  immediately  I 
notice  muscular  fatigue;  the  functional  activity  diminishes, 
and  I  raise  it  less  and  less  high ;  at  last  I  can  no  longer  move 
it.  What  has  happened  ?  Is  it  my  brain  that  has  grown  tired 
of  giving  orders ;  is  it  the  changed  nerve  which  will  no  longer 
transmit  the  voluntary  influx  to  the  muscles?  Is  it  the  per- 
ipheral organs  or  the  terminal  plates  of  the  muscles  that  do 
not  respond  completely  to  the  transmitted  stimulus  ?  Could  it 
be,  after  all,  that  moral  incentives  are  lacking  to  determine 
reactions  which  we  call  voluntary?  Is  the  fatigue  localized, 
or  does  it  occur  everywhere  at  once  throughout  the  whole 
neuro-muscular  apparatus?  This  last  hypothesis  is  the  more 


OF   NERVOUS    DISORDERS          121 

probable,  since  all  work  leads  to  fatigue  and  all  the  organs  act 
simultaneously. 

Physiologists  have  studied  muscular  fatigue  in  the  isolated 
muscle,  and  they  have  proved  that  the  catabolism  of  the  mus- 
cle causes  glycogen,  carbonic  acid,  lactic  acid,  and  other  dele- 
terious substances  to  accumulate  in  the  muscle. 

Muscular  fatigue  may  thus  be  considered  as  an  intoxica- 
tion by  the  products  of  combustion.  An  injection  of  salt  so- 
lution into  the  principal  artery  of  a  muscle  spent  by  repeated 
electrical  stimuli  is  enough,  for  the  moment,  to  overcome  the 
exhaustion  and  to  restore  to  the  muscle  its  power  of  con- 
traction. 

On  the  other  hand,  a  muscle  that  no  longer  responds  to 
cerebral  influences  can  still  react  under  the  influence  of  an 
electric  current;  this  would  make  us  think  that  it  is  the  brain 
which  has  suffered  the  deleterious  influence.  But  one  also 
meets  the  inverse  phenomena:  the  muscle  no  longer  obeys  the 
stimulus  of  the  current,  but  contracts  again  under  the  influence 
of  the  will  or  of  the  reflex.  Thus,  attempts  to  localize  fatigue 
are  foiled,  and  it  becomes  probable  that  the  changes  which 
hinder  the  activity  are  at  the  same  time  central  and  peripheral, 
and  that  fatigue  pervades  the  whole  neuron. 

There  is  an  evident  analogy  between  the  organ  that  tires 
and  the  electric  battery  that  polarizes.  The  potential  of  the 
latter  is  lowered  not  by  the  use  of  the  zinc  that  is  still  present, 
but  chiefly  by  the  accumulation  on  the  electrodes  of  the  prod- 
ucts of  polarization,  and  in  order  to  raise  the  electromotive 
force  it  is  only  necessary  to  eliminate  by  a  slight  shock,  a  breath, 
the  bubbles  of  hydrogen  which  cover  the  carbon.  In  the  same 
way  muscular  fatigue  may  be  dissipated  by  the  elimination  of 
the  toxins  produced  by  the  very  act  of  functioning  of  the 
muscle. 

Regarding  the  other  organs,  and  particularly  the  brain,  we 
are  not  so  well  informed  as  in  the  case  of  the  muscle.  We  have 
no  exact  ideas  concerning  the  toxins  that  accumulate  in  its  tis- 
sue during  cerebral  activity,  or  of  the  effects  produced  by  this 
fatigue,  or  of  the  constancy  of  the  physical  or  mental  symptoms 
which  accompany  it. 


122  PSYCHIC   TREATMENT 

But,  as  has  been  noticed  by  Mosso,1  the  brain  is  eminently 
more  sensitive  than  the  muscle.  There  is  greater  need  than  in 
the  latter  for  the  constant  flow  of  blood,  destined  not  only  to 
bring  to  it  elements  of  nutrition  and  combustion,  but  chiefly  to 
eliminate  functional  wastes  and  deleterious  toxins.  The  muscle 
can  still  contract  normally  when  its  local  circulation  is  sup- 
pressed by  an  Esmarch  bandage.  The  loss  of  consciousness 
occurs,  on  the  other  hand,  in  a  few  seconds,  if  by  pressing  on 
the  carotids  one  hinders  the  flow  of  blood  to  the  brain,  even 
tho  the  large  vessels  and  the  vertebrals  escape  the  compression. 
This  is  the  process  which,  they  say,  the  Japanese  employ  to 
produce  narcosis  in  their  painful  operations. 

The  most  apparent  phenomenon  of  all  fatigue  is  the  grad- 
ual diminution  of  functional  power  and  the  difficulty  of  con- 
tinuing work  already  begun.  But  it  is  accompanied  by  other 
phenomena,  such  as  pain,  contracture,  and  extreme  lassitude. 
If  one  persists,  the  fatigue  extends  over  the  whole  body,  pro- 
ducing breathlessness,  palpitation  of  the  heart,  and  perspira- 
tion; and  in  the  end  is  followed  by  headache  and  mental 
troubles  with  distinct  pessimistic  and  melancholy  tendencies. 
Tissie 1  has  studied  fatigue  following  the  violent  exercises  of 
bicyclists.  "  Enthusiasm  for  exercise,  pushed  to  the  point  of 
excessive  fatigue,  in  well-developed,  healthy,  robust  men,  by 
a  long  course  of  bicycling,  or  walking,  or  by  prolonged  and 
rhythmical  muscular  effort,  provokes  a  sort  of  transient  psy- 
chosis. These  psychoses  have  the  same  exterior  manifesta- 
tions as  the  pathological  psychoses  of  subjects  who  are  morbid,, 
hysterical,  degenerate,  or  insane,  etc.  Such,  for  example,  is 
the  ennui  to  which  they  are  all  subject,  and  which  always  comes 
on,  even  in  the  most  cheerful  and  best  balanced,  the  moment 
they  give  themselves  up  to  any  intense  enthusiasm." 

Fere *  also  pointed  out  the  mental  troubles  of  fatigue,  and 
insisted  on  the  analogies  which  they  present  to  the  mental 
troubles  of  neurasthenia. 


1  A.  Mosso.    La  Fatica,  quinta  edizione.     Milnuo,  1892. 

*  Ph.TIsse1.  "I/entrainement  intensif  ibicyclette."  Revue Scientifique, October,  1894. 
"I,a  fatigue  chez  les  debiles  nerveur  ou  fatigues."  Revue Scieniifiqve,  October,  1896. 
1  Fere.  "I,e8  troubles  mentauz  de  la  fatigue."  Medicine  modeme,  November,  1898. 


OF   NERVOUS    DISORDERS          123 

"  It  (the  fatigue)  often  provokes  ideas  of  negation,  of  per- 
secution, of  disparagement.  Altruistic  feelings  give  place  to 
selfishness,  which  shows  itself  under  the  most  varied  forms. 
The  subject  is  incapable  of  reacting  against  obsessions  and 
impulses  which  may  become  irresistible." 

And  further  on :  "  Fatigue  permits  a  tendency  toward 
depression  of  feelings  and  a  general  pessimism." 

These  ideas  are  fundamental  in  the  study  of  psychoneuroses. 
Fatigue,  when  it  is  pushed  to  excess,  exercises  a  sorry  influence 
on  the  mentality  of  a  healthy  and  robust  man,  and  gives  rise  to 
the  different  symptoms  of  the  psychoneuroses.  It  is  evident 
that  fatigue  will  act  more  powerfully  and  more  quickly  on 
individuals  who  are  already  suffering  from  natural  nervous 
weakness.  A  trifle  is  then  enough  to  upset  their  mental 
equilibrium. 

I  go  still  further,  and  recognize  in  what  is  called  fatigue 
a  psychic  element  which  has  not  been  sufficiently  taken  into 
account ;  I  mean  the  conviction  of  fatigue,  which  is  by  no  means 
proportioned  to  real  exhaustion,  and  which  owes  its  origin  to 
our  natural  pessimism,  which  is  exaggerated  still  more  by  the 
fatigue  itself.  True  fatigue  is  doubled  by  the  autosuggestion 
of  fatigue ;  there  is  ennui  and  discouragement  in  our  lassitude. 

We  may  apply  this  distinction  to  all  kinds  of  fatigue,  and 
the  facts  that  permit  us  to  do  so  are  observed  every  day  in  the 
healthy  man. 

Soldiers  are  on  a  forced  march.  They  can  go  no  further, 
and  some  lie  down  alongside  the  road,  and  declare  that  they  are 
unable  to  take  another  step.  Let  an  officer  happen  along  who 
knows  how  to  bring  up  the  morale  of  his  troops,  let  the  music 
of  the  regiment  be  played,  and  you  will  see  these  men  resume 
their  march  almost  at  a  quickstep. 

Were  those  men  exhausted,  then?  No;  for  in  that  case  it 
would  have  been  necessary  to  allow  them  rest  and  to  feed  them, 
or  else  to  leave  them  behind  or  take  them  along  in  the  ambu- 
lance. They  were  fatigued,  but  under  the  influence  of  fatigue 
their  morale  had  weakened,  and  they  saw  their  fatigue  through 
the  magnifying-glass  of  their  unhealthy  pessimism.  The  word 
of  their  chief  and  the  music  restored  their  good  spirits  and 


124 


PSYCHIC  TREATMENT 


enthusiasm,  and  that  is  why  they  went  on  marching.  The 
feeling  of  imminent  danger,  as  of  the  enemy  on  their  heels, 
would  have  acted  in  the  same  way  and  strengthened  their  legs. 

By  these  questions  one  abuses  the  term  dynamogeny.  I  do 
not,  by  any  means,  wish  to  imply  that  a  sensory  stimulus  can 
have  no  direct  influence  on  the  muscular  force ;  various  physio- 
logical experiments  seem  to  establish  this  action.  But  I  refuse 
to  recognize  a  dynamogenic  action  in  the  facts  which  I  here 
note. 

Encouragement  does  not  create  strength,  it  can  only  free 


FIG.    I 


preexisting  energies.  Rest  and  food  alone  can  restore  to  the 
organ  the  strength  which  it  lacks ;  the  first  permitting  the  repair 
of  the  cell  and  the  elimination  of  toxins,  and  the  latter  bringing 
it  nutritive  materials. 

The  psychic  stimulant  acts  by  another  channel  on  the  most 
delicate  and  most  active  elements  of  the  thinking  brain.  It 
dispels  sad  feelings  and  that  desire  for  idleness  which  we  so 
complacently  call  fatigue.  For  just  as  the  conviction  of  lack 
of  power  creates  poworlessness,  so  strength  can.  also  return  as 
soon  as  one  feels  that  he  possesses  it. 


OF  NERVOUS    DISORDERS 


125 


The  researches  by  the  aid  of  the  ergograph  of  Mosso  give 
a  very  clear  idea  of  what  may  be  called  true  fatigue  or  real 
exhaustion. 

For  the  use  of  my  clinic  I  have  constructed  an  ergograph  1 
( Fig.  I )  that  is  very  simple  and  always  ready  for  use.  It  con- 
sists of  a  slide  with  a  pully,  on  which  runs  a  little  cord,  support- 
ing a  weight  of  from  10  to  16  pounds.  The  experimenter 
places  his  wrist,  with  the  hand  extended,  on  the  board,  passes 
his  index  finger  through  the  loop  of  the  cord,  and  raises  the 


60 

A 

40 

30 
20 
10 


FIG.    2 


weight  rhythmically — as,  for  example,  every  two  seconds.  The 
apparatus  traces  automatically  on  ruled  paper  (Fig.  2)  the 
height  of  the  elevation.  One  thus  obtains  a  curve  of  decreas- 
ing ordinates,  whose  value  can  easily  be  determined  in  kilo- 
meters, by  multiplying  the  weight  raised  by  the  height  of  the 
ordinate.  In  man  this  curve  has  a  characteristic  form. 

If  one  eliminates  a  few  possible  irregularities  at  the  start, 
when  the  finger  is  not  quite  adjusted,  the  first  contraction  is 
the  highest;  the  following  decrease  very  slowly.  The  differ- 
ence between  any  two  successive  ordinates  increases  more  and 


1  The  instrument  is  manufactured  by  the  house  of  E.  Zimmerman,  of  I,eipsig. 


126  PSYCHIC   TREATMENT 

more,  and  soon  the  fall  of  the  curve  is  sharply  marked.  It 
looks  as  though  the  muscle  would  soon  be  exhausted.  But  in 
proportion  as  the  ordinates  are  lower,  the  curve  is  prolonged. 
It  still  grows  lower,  but  with  less  rapidity,  so  that  if  one  draws 
a  straight  line,  A  B,  between  the  summit  of  the  greatest  ordi- 
nate  and  the  last  ordinate,  which  is  the  abscissa,  the  curve 
presents  this  characteristic  form:  <~->.  The  ordinates  of  the 
first  half  of  the  curve  are  above  the  oblique  line,  those  at  the 
end  below  it.  This  form  (<— ')  has  its  reason ;  in  proportion  as 
the  ordinates  decrease,  the  muscle  works  less,  the  kilometric 
effort  is  slighter,  and,  in  a  certain  degree,  the  muscle  rests ;  by 
working  less  it  can  work  for  a  longer  time.  Here,  then,  is  a 
physiological  law  which  applies  to  all  kinds  of  work.  Fatigue 
leads  to  relative  rest  by  the  very  reason  of  the  diminution  of  the 
functional  activity  which  it  involves. 

This  typical  curve  is  always  found  the  same  in  the  same 
individual.  Thus  it  offers  the  following  characteristics: 

1.  Fatigue  is  evidenced  from  the  beginning  of  the  exercise,  it 

commences  with  the  work. 

2.  The  decreasing  curve  has  manifestly  such  a  form:  <— -. 

3.  Each  of  the  ordinates  traced  marks  the  maximum  effort  of 

which  the  muscle  is  capable  at  the  moment  when  it 
traces  it. 

4.  When  the  exercise  is  finished,  so  that  the  index  finger  can 

no  longer  raise  the  weight,  exhaustion  is  complete.  No 
amount  of  encouragement  can  induce  further  contrac- 
tion; there  is  no  possibility  of  dynamogeny  by  any 
psychic  means. 

On  the  other  hand,  the  slightest  rest  of  a  few  seconds  is 
enough  to  restore  the  faculty  of  contraction  to  the  muscle. 
At  the  end  of  a  minute  the  muscle  has  recovered  thirty  to  fifty 
per  cent,  of  its  primitive  strength.  If,  after  regular  intervals  of 
rest  for  one  minute,  one  traces  successive  curves,  one  will  find 
in  the  collection  of  these  curves  the  peculiarities  of  the  single 
curve.  Each  of  these  curves  has  a  total  kilometric  value  that 
is  vreaker  than  the  preceding  one.  The  decline  of  power  takes 
place  rapidly  at  the  beginning  and  more  slowly  afterward,  so 
that  one  again  finds  this  characteristic  form  of  the  curve :  — •. 


OF  NERVOUS   DISORDERS          127 

Such  is  the  curve  of  true  fatigue,  independent  of  all  moral 
influence. 

Is  this  the  curve  of  ordinary  fatigue  of  which  we  speak 
every  day,  whether  we  bring  it  about  by  physical  effort  or 
whether  we  apply  ourselves  to  intellectual  work,  or  succumb 
under  the  burden  of  misfortune  or  moral  emotions?  No. 
With  such  true  experimental  fatigue,  in  which  each  ordinate 
represents  all  the  effort  possible,  and  the  zero,  absolute  exhaus- 
tion, we  must  contrast  ordinary  fatigue,  that  which  is  always 
influenced  by  the  moral  stamina  and  the  mental  condition  of 
the  subject. 

One  sometimes  sees  a  man,  under  the  influence  of  anger 
or  mad  fury,  put  forth  incredible  muscular  strength  which  no 
one  would  have  believed  him  to  possess.  Any  encouragement 
can  also  provoke  a  renewal  of  his  power ;  but  that  is  not  the  cre- 
ation of  strength,  that  is  only  a  complete  letting  loose  of  latent 
energy.  This  exuberance  is  due  only  to  suppression  by  pre- 
vious inhibitions. 

One  finds  the  same  phenomena  in  the  intellectual  and 
moral  life.  There  are  some  people  who  seem  to  become  witty 
when  they  have  been  drinking.  Is  alcohol  really  capable  of 
giving  us  faculties  which  we  do  not  possess  when  we  have  not 
been  drinking  ?  No.  It  merely  suppresses  the  obstacles  which 
are  created  for  us  by  our  habitual  mental  state,  our  timidity, 
and  our  desire  to  do  the  correct  and  proper  thing.  In  order 
to  make  a  speech  it  is  necessary  to  allow  free  course  to  one's 
imagination  and  satire,  and  to  shake  off  certain  psychic  fetters. 
Alcohol  produces  this  effect,  paralyzing  our  moral  sense. 
Thus,  if  a  certain  dose  of  alcohol  be  exceeded,  you  will  notice 
that  the  discourse  becomes  still  more  lively  but  more  incoher- 
ent; the  orator  goes  so  far  as  to  lose  all  feeling  for  the  pro- 
prieties and  all  human  respect. 

If,  under  the  influence  of  alcohol  or  coffee,  or  the  intoxica- 
tion which  results  from  high  spirits,  a  man  is  made  to  appear 
witty  or  good-hearted,  or  an  original  thinker,  be  sure  that  he 
really  posseses  these  qualities  at  the  bottom  of  his  soul,  and 
that  if  they  are  not  apparent  every  day  it  is  because  they  are 
repressed  by  concomitant  mental  states  which  do  not  allow 


128  PSYCHIC  TREATMENT 

these  latent  energies  to  exhibit  themselves.  There  is  a  certain 
truth  in  the  adage :  "  One  speaks  the  truth  in  wine  "  (In  vino 
veritas}. 

I  have  tried  to  take  some  ergographic  curves  in  neurasthenic 
patients.  They  have  nothing  characteristic,  and  vary  accord- 
ing to  the  mental  state  of  the  subject. 

A  certain  patient,  overcome  by  laziness,  and  imbued  with 
the  sense  of  helplessness,  gives  up  tracing  his  curve  before  it  is 
even  begun;  he  is  ponophobic.  Another  abstractedly  traces  a 
few  ordinates  that  are  pretty  high,  then,  feeling  discouraged, 
he  can  no  longer  lift  the  weight,  altho  the  preceding  contraction 
was  fairly  strong;  there  is  no  gradual  normal  decrease.  A 
third  describes  a  regular  curve  with  unexpected  variations,  but 
the  ordinates  are  lower  than  those  of  a  normal  man  who  seems 
equipped  with  the  same  muscles.  It  is  difficult  to  say  in  this 
last  case  whether  it  is  true  weakness  or  only  a  conviction  of 
powerlessness ;  but  one  gets  the  impression  that  the  subject 
under  experiment,  by  virtue  of  his  mental  state,  has  not  made 
the  maximum  possible  effort  each  time  he  pulled  the  weight. 

In  fact,  I  have  seen  neurasthenic  physicians  pretend  that 
they  were  in  a  state  of  complete  amyosthenia  (with  loss  of 
muscular  contraction)  and  incapable  of  using  their  arms,  yet, 
on  becoming  suddenly  interested  in  the  experiment,  the  same 
men  have  found  undreamed-of  strength,  and  produced  an  ergo- 
graphic  curve  above  the  average. 

It  is  impossible  to  disregard  in  these  variations  of  psychic 
influence,  the  predominant  effect  of  the  contingent  mental  state. 

It  is  the  same  in  the  intellectual  domain.  We  wake  up  some 
morning  feeling  languid  and  depressed,  perhaps  without  any 
known  cause,  perhaps  on  account  of  a  bad  night  or  previous 
fatigue.  We  refuse  to  give  in  to  this  feeling  of  powerlessness, 
and  we  resolutely  set  ourselves  to  work  with  the  idea  that  we 
may  "swing  into  the  stream."  Sometimes  we  succeed  in  getting 
into  the  spirit ;  at  other  times  all  our  effort  is  vain,  and  we  ac- 
knowledge our  incapacity  with  regret.  But  good  news  comes, 
a  friend  encourages  us,  or  we  receive  a  flattering  letter,  which 
gives  us  back  our  confidence  in  ourselves,  and  suddenly  we 
recover  our  spirits  and  the  full  possession  of  our  powers.  Is 


OF  NERVOUS   DISORDERS          129 

this  dynamogeny,  the  evolution  of  the  physical  force  ?  No ;  it 
is  dynamophany,  the  expression  of  psychic  force. 

When  we  declare  ourselves  physically  or  intellectually  fa- 
tigued we  admit  our  actual  incapacity  as  a  whole.  Our  fatigue 
seems  to  us  like  a  fruit  whose  exterior  form  we  can  only  ap- 
preciate at  first  in  the  mass  without  knowing  its  interior  con- 
struction. If  we  cut  it  in  two  we  shall  perhaps  find  that  it  Is 
only  a  small,  succulent  nut,  but  surrounded  by  a  thick,  fibrous 
shell.  Let  us  analyze  our  fatigue,  and  we  shall  see  that  there 
is  often  only  an  almost  imperceptible  nucleus  of  true  fatigue 
lost  in  an  enormous  mass  of  autosuggestion  of  fatigue. 

It  would  not  be  exact  to  say  that  this  is  imaginary  fatigue ; 
it  is  a  conviction  of  loss  of  power  which  follows  a  sensation 
that  is  real,  but  that  is  magnified  by  the  pessimistic  state  of 
mind  which  fatigue  itself  has  induced  by  acting  on  our  moral 
nature.  This  mental  state  has  a  psychic  and  cerebral  sub- 
stratum. It  is  a  diseased  condition.  It  may  improve  slowly 
with  rest  and  strengthening  food.  It  can  vanish  still  more 
rapidly  under  the  influence  of  an  idea,  or  of  a  feeling  which 
stimulates  cerebral  action  and  dissipates  the  cellular  disturb- 
ance and  the  inhibition  which  it  produces.  This  distinction 
between  true  exhaustion  and  the  autosuggestion  of  fatigue  has 
not  escaped  general  notice,  but,  ignorant  of  the  truth  of  biologic 
determinism,  the  public  describes  as  laziness,  or  languor,  that 
incapacity  which  seems  to  be  out  of  proportion  to  the  work 
accomplished,  or  which  shows  itself  before  any  effort  is  made. 
It  does  not  take  into  account  the  fact  that  it  is  the  morale  that 
is  tired,  that  there  is  a  pathological  state  of  mind  that  is  in 
such  cases  always  connected  with  some  change  of  the  thinking 
organ. 

It  is  chiefly  when  we  examine  the  conduct  of  others  that  we 
arrive  at  this  rather  uncharitable  conception  and  are  lavish 
with  our  reproaches.  We  are  more  gently  indulgent  when  we 
are  stating  our  own  incapacity.  With  ourselves  it  is  fatigue, 
exhaustion,  sickness ;  with  our  neighbor  it  is  called  laziness, 
carelessness,  and  whims. 

Whether  slight  or  excessive,  transient  or  lasting,  laziness 
may  be  considered  as  much  a  mental  disease  as  a  fault  of  char- 


130  PSYCHIC   TREATMENT 

acter.  In  many  places  it  disappears  under  the  dynamophanic 
action  of  encouragement,  or  of  a  strengthening  mental  repre- 
sentation. In  other  cases  the  nucleus  of  real  fatigue  is  greater, 
and  rest  of  more  or  less  duration  must  follow.  The  task  of 
the  physician  or  the  educator,  when  he  has  to  do  with  such  a 
condition  of  incapacity,  is  not  to  count  up  the  responsibilities, 
and  distribute  blame  to  the  wrong-doers  and  indulgence  to 
those  who  call  themselves  sick.  His  only  duty  is  to  analyze 
with  care  the  physical  and  psychic  condition  of  the  subject, 
to  discover  the  point  at  which  he  can  apply  the  lever  in  order 
to  lift  him  into  a  state  of  activity.  To  give  birth  to  the  senti- 
ments inspired  by  duty  and  to  excite  altruistic  feelings  is  to  do 
a  useful  work,  both  in  those  conditions  which  the  public  con- 
siders diseased  and  in  those  for  which  it  reserves  the  epithet 
of  lazy. 

The  art  of  the  physician  lies  just  in  choosing  in  each  case 
the  most  rapid  and  powerful  means  of  improvement.  Here  it 
will  be  more  or  less  complete  repose,  lasting  for  a  greater  or 
less  time ;  here  a  little  ecouragement  or  moral  influence  will  be 
enough;  but  he  must  be  careful  not  to  conclude  that  the  one 
method  or  the  other  marks  the  exact  limit  between  sickness 
and  fault.  There  are  subjects  whose  incapacity  is  consider- 
able and  of  long  standing,  and  who  suffer  from  various  nervous 
symptoms,  such  as  headache,  digestive  troubles,  and  loss  of 
weight,  but  who  recover  their  brave  spirit  after  a  single  psy- 
chotherapic  conversation,  altho  a  diseased  condition  was  evi- 
dently present.  There  are  others  who,  tho  free  from  all  pain- 
ful symptoms,  nevertheless  suffer  all  their  lives  from  a  patho- 
logical languor  and  a  moral  weakness  against  which  all 
physical  or  moral  treatment  may  strive  in  vain. 

This  analysis  of  fatigue  is  fundamental  for  the  physician 
who  wants  to  use  psychotherapic  influence.  He  must  recog- 
nize in  himself  the  part  that  the  morale  plays  in  the  develop- 
ment of  feelings  of  exhaustion.  He  must  know  how  to  conduct 
his  patient  into  the  labyrinth  of  this  psychological  analysis  of 
his  own  sensations.  In  the  greater  number  of  cases  the  only 
way  to  cure  it  is  to  rapidly  suppress  the  psychic  disorder,  and 
once  for  all  to  give  the  subject — if  we  may  not  rather  say  the 


OF   NERVOUS    DISORDERS          131 

patient — that  feeling  which  alone  can  create  power,  namely, 
the  conviction  of  power. 

In  our  appreciation  of  fatigue  we  still  make  other  errors 
which  are  often  serious  in  their  consequences.  Certain  per- 
sons apply  this  term  fatigue  to  diseased  symptoms  which  have 
nothing  to  do  with  exhaustion.  Thus,  epileptics  often  mention 
their  "  tired  feelings,"  by  which  they  mean  their  attacks  of 
petit  mal.  Very  often  neurotics  call  fatigue  a  combination  of 
feelings  which  they  experience  on  waking  after  a  period  of 
prolonged  rest.  They  are  right  in  this  sense,  that  the  symp- 
toms are  just  those  which  we  feel  in  fatigue:  weakness,  exces- 
sive lassitude,  headache,  and  inability  to  work.  But  one  ought 
not  to  speak  of  fatigue  where  there  has  been  no  work.  The 
analogy  of  the  symptoms  does  not  imply  the  identity  of  their 
causes. 

In  many  cases  the  error  consists  of  attributing  to  the  fatigue 
that  is  felt  other  than  the  true  causes.  This  is  another  instance 
of  the  hasty  conclusion  following  the  adage :  "  Post  hoc,  ergo 
propter  hoc."  This  error  leads  us  to  take  useless  measures  to 
suppress  a  useful  effort,  while  allowing  those  irregular  habits 
to  continue  which  were  the  sole  causes  of  the  disease. 

Whatever  may  be  the  mistakes  that  he  has  made,  whether 
he  deceives  himself  concerning  the  symptoms  or  their  causes, 
or  whether  he  sees  his  fatigue  through  a  magnifying-glass,  the 
neurotic  finds  himself  in  the  same  situation  as  one  who  has  been 
hypnotized  or  under  the  influence  of  a  suggestion.  He  has 
allowed  a  false  idea  to  creep  into  his  mind;  it  develops  there 
more  or  less  logically,  and  from  that  time  on  he  is  powerless 
just  in  proportion  as  he  believes  himself  powerless.  On  the 
one  hand  he  thinks  himself  sicker  than  he  is,  on  the  other  hand 
he  tries  to  avoid  influences  which  he  considers  hurtful.  Faint- 
hearted, in  the  first  place,  and  seeing  the  increasing  failure  of 
these  ill-calculated  hygienic  measures,  he  is  apt  to  become  po- 
nophobic  and  hypochondriacal. 

We  shall  find  everywhere,  in  the  history  of  phychoneuroses, 
the  disastrous  influence  of  erroneous  ideas,  whether  they  be  due 
to  an  excusable  ignorance,  or  whether,  as  is  more  often  the  case, 
they  result  from  the  irrational  mentality  of  the  subject. 


132  PSYCHIC   TREATMENT 

I  do  not  hesitate  to  submit  to  my  patients  these  considera- 
tions on  fatigue  and  to  show  them  that  in  nursing  their  sus- 
ceptibility they  are  not  to  be  compared  to  paupers,  but  to  those 
cowardly  beings  who,  tho  enjoying  a  certain  ease,  are  always 
thinking  that  they  are  going  to  be  left  in  poverty. 

We  are  all  of  us  like  this  in  different  degrees.  Tho  we 
sometimes  become  presumptuous,  we  more  often  lack  confi- 
dence in  our  own  strength. 


OF  NERVOUS   DISORDERS          133 


CHAPTER   XI 

-Sensibility  the  First  Condition  of  All  Physiological  Activity — Sensation: 
Its  Psychic  Character — Constant  Influence  of  the  Idea,  of  Autosug- 
gestions, on  Our  Various  Sensibilities  to  Physical  Agents :  Air, 
Barometric  Pressure,  Temperature,  Electricity.  Light,  Food 

THE  cell  does  not  act,  it  reacts.  Sensibility,  in  its  most 
general  sense,  is  thus  the  first  condition  of  all  physiological 
activity.  It  is  necessary  to  have  a  stimulus  to  start  up  the 
latent  energies  accumulated  by  the  deposit  of  calories  or  econo- 
mized by  rest.  These  stimuli  are  always  external  to  the  cell, 
the  organ,  or  organism  that  reacts,  but  it  is  customary  to  dis- 
tinguish those  which  start  in  the  periphery  or  the  external 
tegument,  as  organs  of  sense,  from  those  which  arise  in  the 
depths  of  the  organism,  in  the  splanchnic  organs  or  in  the  cell 
bodies  themselves. 

Whichever  they  may  be,  these  stimuli  awaken  at  one  and  the 
same  time  the  functioning  of  lower  centers,  the  simple  or  com- 
plicated reflexes  which  are  studied  in  physiology,  and  those 
very  delicate  and  complex  reflexes  which  are  called  association 
of  ideas  and  mental  representations.  And  the  nervous  wave 
does  not  stop  there;  from  being  centripetal  it  becomes  cen- 
trifugal, and  the  gesture  accompanies  the  idea  with  the  con- 
stancy of  the  most  common  reflex — so  much  so  that  one  can 
say  that  mental  representation  is  already  an  act  begun. 

The  majority  of  sensations  which  directly,  by  the  way  of 
a  reflex  or  by  the  intermediary  of  mental  representations,  are 
the  determining  causes  of  our  acts,  enter  our  understanding 
by  the  way  of  our  five  senses.  These  are,  as  I  have  said,  our 
antennae ;  it  is  by  them  that  we  come  in  contact  with  the  out- 
side world.  It  is  by  these  channels  to  sensibility  that  our 
fellows  act  upon  us,  and  that  those  heterosuggestions  come  to 
us  which  we  often  obey  with  too  much  passivity. 

Since  the  world  began  we  see  nothing  in  action  but  these 


134  PSYCHIC   TREATMENT 

five  senses,  and  our  sensibility  is  so  well  equipped  by  this 
abundance  of  receptive  organs  that  we  have  no  reason  to  sup- 
pose the  existence  of  a  sixth  sense,  or  still  others,  establishing 
mysterious  fluid  relations  between  human  beings.  Still  vaguer 
sensations,  which  are  but  slightly  differentiated,  arise  in  the 
organism  itself,  from  the  depths  of  our  being,  incited  by  the 
functioning  of  the  inferior  centers,  which  is  itself  always 
reflex.  Here  is  the  source  from  which  there  arise  numerous 
obscure  motor  impulses  of  the  sensibility,  which  also  determine 
our  reactions  when  we  do  not  oppose  them  by  the  superior 
motives  of  reason. 

The  study  of  sensibility  is  thus  of  major  importance  to  the 
psychologist.  Unfortunately,  in  order  to  simplify  the  problem 
and  to  solve  it,  he  has  narrowed  its  scope  too  much.  Psycholo- 
gists have  studied  merely  sensations  which  are  always  more  or 
less  identical,  and  which,  in  certain  measure,  are  determined  by 
the  stimulus,  whether  natural  or  artificial. 

It  is  thus  that  it  has  been  possible  to  determine,  with  more 
or  less  precision,  for  the  five  senses,  the  threshold  of  the  exci- 
tation, the  extreme  limit  of  the  reaction,  and  the  maximum 
where  the  element  of  pain  appears.  It  has  been  possible  to 
arrange  tables  of  sensibility  according  to  the  law  of  Weber 
for  electric  excitation,  and  to  determine  the  limits  of  sight, 
hearing,  etc. 

This  work  was  useful  and  necessary,  but  it  is  only  the 
a,  b,  c  in  the  study  of  sensibility. 

In  experimenting  on  man  it  is  very  quickly  perceived  that 
the  reactions  vary  from  one  individual  to  another ;  that  we  can 
easily  guage  the  stimulus,  but  that  it  is  often  impossible  for  us 
to  appreciate  the  reaction.  As  for  the  motor  nerves,  a  move- 
ment is  produced,  and  it  is  possible  to  state  the  extent  of  it, 
and  to  measure  the  mechanical  effort  developed.  But  for  sen- 
sation, the  control  escapes  us,  for  it  is  always  subjective;  it  is 
not  translated  by  measurable  external  phenomena.  As  soon 
as  the  reaction  of  an  individual  to  a  stimulus  seems  to  pass 
the  ordinary  limits  so  that  it  becomes  distressing  or  painful, 
even  tho  it  may  not  be  so  for  others,  one  admits  a  diseased 


OF   NERVOUS    DISORDERS          135 

condition  or  an  habitual  idiosyncrasy,  and  it  is  to  the  nerves 
that  one  relegates  this  state  of  hyperexcitability. 

If  remote  or  peculiar  reactions  follow  the  excitation,  one 
tries  to  explain  them  physically,  or  physiologically,  attributing 
a  dynamogenic  action  to  a  luminous  ray,  or  a  weakening  in- 
fluence to  such  or  such  meteorological  conditions.  It  seems 
as  though  one  were  studying  exact  phenomena  that  could  be 
measured,  or  the  definite  relations  of  cause  and  effect. 

One  forgets,  however,  the  truth  that  is  easy  to  recognize : 
that  is,  that  all  sensation  is  a  fact  on  the  psychic  order,  that,  in 
short,  it  is  always  what  we  call  the  soul  that  feels. 

The  physical  element  in  the  phenomena  of  pain  provoked 
by  the  prick  of  a  needle  is  the  tearing  apart  of  the  terminal 
threads  of  the  sensitive  nerves.  The  physiological  element  is 
the  transmission  of  the  nervous  vibration  along  the  nervous 
filament  with  the  rapidity  of  about  thirty  meters  to  the  second, 
but  the  psychic  element  is  the  sensation  itself,  the  perception 
of  the  pain  that  is  received  in  certain  special  centers  whose 
location  is  not  known  but  which  must  be  situated  in  the  cortex 
of  the  brain. 

While  at  the  periphery,  in  the  conductors,  and  the  medul- 
lary centers,  the  bulbar  and  lower  cerebral  centers,  the  reactions 
take  place  with  an  almost  mechanical  regularity,  the  perception 
of  the  sensation  may  vary,  on  the  contrary,  according  to  the 
mental  condition  of  the  subject.  Sensation  may  be  destroyed 
by  distraction,  by  an  inhibiting  autosuggestion ;  it  may  be  ren- 
dered more  acute  or  greater  by  expectation,  or  by  attention; 
it  may  be  created  out  of  nothing  at  all  in  the  absence  of  a  true 
stimulus,  by  a  mental  representation.  It  is  this  intervention 
of  the  idea  which  makes  the  study  of  sensibility  so  difficult, 
like  that  of  all  phenomena  where  we  have  as  criterion  only  the 
statements  of  the  subject  under  experiment. 

Thus  I  should  be  able  to  include  the  study  of  fatigue  in  that 
of  sensibility.  We  judge  fatigue  only  by  the  sensations  which 
we  experience,  and  that  is  why  the  psychologists  tax  their 
ingenuity  to  measure  it  with  the  help  of  ergographs  and  aes- 
thesiometers  and  precise  experiments  that  are  often  repeated, 
and  intended  to  eliminate  the  errors  due  to  the  mentality  of 


136  PSYCHIC   TREATMENT 

the  subject.  Practically  we  do  not  think  enough  about  the 
difficulty  of  the  task.  We  all  have  the  tendency  to  believe,  not 
only  in  the  reality  of  our  sensations,  which  would  be  only 
natural,  for  they  are  always  real  to  us,  but  in  the  reality  of  the 
complete  phenomenon,  the  certain  peripheral  stimulus,  the 
transmission  of  the  nervous  wave,  and  the  final  reception  in 
the  psychical  receptive  center. 

It  is  nothing  of  the  kind.  All  sensation  remains  a  pure 
psychic  phenomenon,  and  the  proof  of  its  existence  does  not 
always  teach  us  the  nature  of  its  cause.  It  is  only  by  the  con- 
trol of  other  senses,  by  induction  based  on  previous  demon- 
strations, often  only  with  the  aid  of  a  third,  that  we  can  avoid 
error  and  assign  to  that  mental  image,  which  is  the  sensation, 
its  determining  causes. 

Let  us  analyze,  in  the  light  of  these  ideas,  the  facts  of  sen- 
sibility which  have  been  observed  in  the  healthy  or  patho- 
logical condition. 

The  majority  of  physical  agents  act  more  or  less  upon  man. 
Thus  pure  air  is  necessary  for  the  proper  functioning  of  our 
organs.  Oxygen  acts  upon  the  functions  of  nutrition  and  aug- 
ments the  number  of  blood  globules.  Some  researches  of  Fere 
seem  to  show  that  by  breathing  oxygen  the  energy,  according 
to  the  dynamometer,  is  augmented,  the  time  of  reaction  dimin- 
ished. The  air,  vitiated  by  carbonic  acid  gas  or  by  other  gases, 
produces  the  contrary  effects  of  depression,  headache,  nausea, 
and  psychical  depression. 

These  are  definite  effects,  caused  directly  by  the  intoxica- 
tion of  the  nervous  centers.  They  occur  in  the  best-balanced 
person,  in  one  who  is  least  apt  to  succumb  to  autosuggestion. 
There  is,  however,  the  possibility  of  idiosyncrasies.  The  or- 
ganism of  one  subject  may  be  more  sensitive  than  others  to 
physiological  influences. 

But  this  natural  need  for  pure  air  passes  all  bounds  in 
nervous  persons  and  in  some  people  who  believe  themselves 
in  good  health. 

There  are  some  people  who  are  perfect  fanatics  about 
having  the  window  open  at  night.  You  will  see  that  in  the 
majority  of  cases  this  sensibility  is  altogether  a  thing  of  auto* 


OF  NERVOUS   DISORDERS          137 

suggestion,  and  if  you  can  close  the  window  after  they  have 
gone  to  sleep  and  open  it  before  they  waken  they  will  never 
perceive  the  deception. 

There  are  thousands  of  nervous  people  who  have  headaches 
the  moment  they  see  a  heater,  especially  if  it  be  made  of  cast 
iron,  for  they  have  learned  that  iron  heated  red-hot  can  let 
deleterious  gases  pass  through  it.  They  positively  see  carbon 
dioxid  let  loose,  and  they  immediately  suffer  from  its  effects. 
There  are  certain  ladies  who  will  fall  in  a  faint  from  having 
used  a  flat-iron  to  iron  for  a  few  moments  in  a  well-aired  place ; 
odors,  even  those  that  are  pleasant,  such  of  those  of  favorite 
flowers,  sometimes  cause  sickness  of  the  stomach,  or  insomnia, 
or  syncope. 

I  know  that  this  sensibility  is  often  real,  and  we  have  no 
right  to  deny  the  reality  of  these  effects  on  account  of  the 
simple  fact  that  we  have  not  felt  them  to  the  same  degree  our- 
selves. But  often  these  sensibilities  bear  the  mark  of  exagger- 
ation; one  discovers  the  influence  of  preconceived  ideas,  and 
detects  autosuggestion  under  the  sensibility.  The  conclusion  is 
confirmed  by  the  extreme  ease  with  which  one  is  able  to  rescue 
the  patient  from  this  so-called  hyperexcitability.  A  single  con- 
versation is  often  enough  to  dissipate  these  prejudices  and  to 
lead  the  patient  back  to  the  habits  of  the  normal  life.  They 
are  the  first  to  laugh  at  their  fears  and  to  acknowledge  their 
autosuggestive  origin.  Often,  suddenly  convinced  by  logic, 
they  apply  this  mental  treatment  to  other  sensations,  and  thus 
learn  to  test  all  their  sensations. 

The  variations  of  atmospheric  pressure  have  undoubtedly 
an  influence  on  health.  Its  diminution  leads  to  muscular  weak- 
ness, especially  if  there  is  accompanying  fatigue,  as  in  the  case 
of  mountain  sickness.  There  is,  on  the  contrary,  a  sensation 
of  well-being  when  the  pressure  is  increased.  It  is  very  rare 
that  nervous  patients  complain  of  sickness  brought  on  by  vari- 
ations of  the  barometer.  The  ladies,  who  furnish  the  best 
examples  of  autosuggestion,  are,  as  a  rule,  ignorant  of  the 
workings  of  the  barometer.  They  lack  a  basis  on  which  to 
work  up  the  mental  representation  which  would  give  rise  to 
the  sensation. 


138  PSYCHIC   TREATMENT 

The  temperature  of  the  air  also  has  its  effect  upon  us.  A 
medium  temperature  is  the  most  favorable  for  our  bodies; 
it  augments  muscular  activity  and  creates  a  feeling  of  well- 
being,  especially  if  the  sun  cheers  us  with  his  rays.  There  is 
depression  if  the  heat  becomes  too  great,  if  it  rises  above  30°  C. 
A  moderate,  dry,  cold  is  well  borne ;  nevertheless,  it  retards  the 
functioning  of  the  nervous  system  and  enervates  the  muscles. 
Acting  on  the  brain,  it  engenders  sadness ;  and  it  is  apt  to  be  in 
autumn  or  at  the  beginning  of  winter  that  we  find,  in  persons 
who  are  so  predisposed,  the  beginning  of  melancholic  troubles 
and  suicidal  impulses.  Excessive  heat  also  provokes  insanity, 
but  more  particularly  in  its  excitable  forms,  such  as  mania  and 
transitory  frenzy. 

Let  us  recognize  the  part  which  possible  idiosyncrasies  may 
play,  but  let  us  not  forget  the  influence  of  the  idea  and  of  pre- 
vention. We  can  often  grasp  the  whole  mental  genesis  of 
these  exaggerated  sensibilities  and  follow  the^  development,  in 
logical  appearance,  of  these  hasty  conclusions. 

One  of  my  patients,  twenty-eight  years  of  age,  was  taken, 
without  any  appreciable  cause,  with  various  hysterical  troubles : 
anorexia,  dyspeptic  troubles,  sensations  of  burning  heat  in  the 
back  and  in  the  extremities,  returning  by  fits  and  starts,  and  ac- 
companied by  a  general  condition  of  very  painful  weakness. 
These  nervous  states  are  quite  common  among  women  at  a 
critical  age,  and  are  found  also  in  young  persons,  often  in 
connection  with  the  phenomena  of  puberty,  or  the  menses,  or 
in  matrimonial  preoccupation. 

The  trouble  occurred  at  a  time  when  a  very  severe  cold 
wave  passed  over  the  country  in  which  this  patient  lived. 
What  was  more  natural  than  to  attribute  her  sufferings  to  the 
unusual  cold  and  to  dress  herself  more  warmly?  The  idea 
seemed  so  reasonable  to  her  parents  that  they  encouraged  the 
patient  to  take  still  greater  precautions.  The  spring  came  in 
particularly  warm,  and  the  parents  were  astonished  to  see  the 
trouble  persist;  but,  persuaded  that  the  patient  was  afflicted 
with  a  diseased  nervous  sensibility,  they  still  approved.  The 
summer  arrived,  burning  hot  and  suffocating,  and  the  patient 
still  suffered.  Imbued  with  the  idea  that  the  cold  was  the  first 


OF  NERVOUS    DISORDERS          139 

cause  of  her  troubles,  she  stayed  in  bed,  refused  to  open  the 
window,  or  to  wash  in  cold  water. 

When  in  September,  in  a  room  where  the  thermometer 
marked  22°  C,  I  saw  the  patient  for  the  first  time,  she  had  her 
hands  hidden  under  the  covers.  When  her  sister  brought  her 
a  glass  of  warm  milk  I  saw  her  make  some  movement  with  her 
hands  under  the  clothes ;  she  was  putting  gloves  on  to  take  the 
glass  of  milk.  She  did  not  dare  to  take  hold  of  it  with  her 
bare  thumb  and  finger  for  fear  that  the  feeling  of  cold  would 
bring  on  an  attack ! 

It  was  with  a  pleading  tone  that  she  asked  me :  "Are  you 
going  to  take  my  gloves  off  right  away  ?  "  "  No,"  said  I,  "  I 
shall  not  take  them  off,  but  you  will  not  put  them  on  again 
from  the  day  when  you  see  that  you  are  the  victim  of  foolish 
autosuggestion."  It  took  several  conversations  to  convince 
the  patient,  and  to  throw  down  the  structure  of  her  fixed  ideas 
and  lead  her  back  to  normal  habits.  The  cure  was  rapid,  and 
the  patient,  whom  I  saw  again  after  several  years,  never  had 
any  recurrence  of  the  trouble. 

Many  of  my  patients,  being  highly  susceptible  to  cold,  cover 
themselves  up  more  in  midsummer  than  we  do  in  winter,  and 
their  conversion  is  brought  about  by  conversation  from  day  to 
day  before  any  material  treatment,  such  as  feeding  or  massage, 
would  have  been  able  to  modify  the  peripheral  circulation.  It 
is  quite  evident  that  one  has  here  to  do  with  phobias  and  fixed 
ideas  arriving  by  the  uncertain  path  of  premature  conclusions, 
encouraged  by  the  proof,  as  it  were,  of  the  apparent  relations 
of  cause  and  effect,  a  proof  all  the  more  assured,  in  proportion 
as  the  expectation  of  the  result  looked  for  suffices  to  produce  it. 

Often,  in  establishing  their  false  syllogisms,  the  patients 
show  a  certain  correctness  of  thought  which  augurs  well  for 
their  cure.  Altho  one  may  think  aright,  yet  one  may  be  com- 
pletely deceived  if  the  point  of  departure  is  false,  but  one  easily 
gets  back  to  the  truth  if  the  deviation  is  corrected  at  the  start. 

The  effects  of  the  electrical  condition  of  the  air  upon  the 
normal  man  are  almost  unknown.  The  neuropaths,  on  the  con- 
trary, complain  of  depression  or  excitation  depending  on  the  va- 
rious phenomena,  but,  what  is  a  characteristic  fact,  they  scarcely 


140  PSYCHIC   TREATMENT 

feel  them  except  when  the  disturbances  are  demonstrable  by 
sight  or  hearing — that  is  to  say,  during  storms,  lightning  and 
thunder.  They  also  feel  it  on  the  insulated  stool  of  an  impos- 
ing static  machine,  and  the  effects  can  be  beneficial  or  disas- 
trous, according  to  the  first  idea  that  the  operator  has  incul- 
cated in  his  patients,  or  according  to  those  which  they  have 
suggested  to  themselves.  Many  ladies  are  afraid  of  electricity, 
and  the  first  treatment  easily  produces  fatigue,  weakness,  in- 
somnia, headaches;  while  with  others  the  same  measures  lead 
to  a  feeling  of  calmness  and  sleep,  or  dissipate  their  chronic 
headaches. 

If  you  are  practising  electrotherapy,  try  to  soothe  these 
unhealthy  autosuggestions,  make  your  patient's  mind  easy,  and 
soon  you  will  find  that  your  electric  baths  and  currents  and 
sprays,  and  even  your  great  sparks,  will  have  only  beneficial 
effects. 

It  is  by  a  word,  or  a  gesture,  or  an  attitude  that,  either 
knowingly  and  voluntarily  or  unknown  to  yourself,  you  give 
rise  to  these  so-called  physiological  reactions  and  their  thera- 
peutic effects. 

It  is  often  possible  to  prove  the  preponderating,  and  some- 
times the  only,  influence  of  autosuggestions.  The  experiment 
is  difficult  with  static  electricity,  with  its  induction  currents, 
which  produce  various  sensations:  the  patient  perceives  the 
fraud  if  the  current  is  suppressed;  but  the  experiment  fre- 
quently succeeds  if  one  uses  weak  galvanic  currents. 

The  wife  of  a  confrere  told  me  one  day  that  she  was  par- 
ticularly sensitive  to  the  action  of  electricity ;  the  current  of  a 
single  element  applied  on  the  back  of  the  hand  was  enough  to 
give  her  a  burning  sensation.  I  denied  the  possibility  of  the 
fact ;  she  insisted,  and  called  for  an  immediate  trial.  I  applied 
the  rheophores,  and  at  the  precise  moment  when  the  finger  of 
the  collector  pointed  to  number  one  she  cried  out :  "  Now  that 
burns  me !  "  She  was  quite  repentant  when  I  showed  her  that 
I  had  not  immersed  the  elements. 

In  a  case  of  serious  traumatic  hysteria,  presenting  at  the 
same  time  a  left  hemianesthesia,  the  rarer  phenomenon  of  hys- 
terical strabismus,  of  monocular  polyopia,  and  of  micropsia,  I 


OF  NERVOUS   DISORDERS          141 

used  galvanic  electricity  in  weak  currents.  At  each  applica- 
tion the  patient  complained  of  intense  pain  on  the  whole  right 
side.  I  continued  my  treatment  for  some  days,  then  I  repeated 
the  same  performances  without  a  current.  The  patient  did  not 
perceive  the  suppression  of  the  current,  and  when  I  asked  her 
if  she  still  experienced  the  same  pains  she  replied  in  the  affirma- 
tive. I  showed  her  her  mistake  clearly,  and  after  that  she  no 
longer  complained  of  her  pains.  These  proofs,  when  they  are 
properly  made,  may  serve  as  a  cure. 

An  hysterical  patient  who  had  passed  her  life  as  a  valetu- 
dinarian, and  had  resisted  all  previous  treatments,  had  some 
difficulty  in  understanding  me  when  I  tried  to  explain  to  her 
the  ideogenic  origin  of  her  sufferings. 

When  my  assistant  tested  her  suggestibility  by  the  method 
which  I  have  indicated  above,  the  application  of  the  innocent 
ring  on  the  right  hand  produced  such  pains  that  she  declared 
she  felt  as  tho  her  finger  was  broken. 

From  the  time  that  I  acknowledged  to  her  our  ruse,  and 
showed  that  she  had  herself  created  these  pains  by  her  own 
ideas,  she  was  convinced.  Without  any  hesitation  she  applied 
this  conception  to  her  other  pains,  and  from  that  time  I  had  no 
patient  who  was  more  susceptible  to  psychotherapy. 

Light  also  has  its  biological  importance,  and  it  would  be 
puerile  to  deny  its  action.  But  its  effects  ought  to  be  studied 
with  the  greatest  care  in  healthy  subjects.  As  soon  as  one 
begins  to  make  statements  concerning  neuropathic  patients,  one 
lays  one's  self  open  to  the  greatest  error.  Not  only  would  it 
be  absurd  to  conclude  from  these  experiments  that  analogous 
effects  are  produced  in  a  man  of  sound  mind,  but  it  would  be 
just  as  false  to  believe  that  these  reactions  are  the  result  of  a 
true  hyperesthesia.  Everywhere,  with  such  patients,  one  must 
bear  in  mind  the  constant  and  inevitable  intervention  of  mental 
representations. 

It  is  also  to  autosuggestion  that  I  attribute  the  phenomena 
of  sound  and  taste  phonisms,  of  colored  hearing  and  taste,  as 
noted  by  numerous  authors. 

I  do  not  deny  that  the  patients  experience  associated  sen- 
sations, that  they  see  a  red  A  and  a  yellow  U ;  but  I  have  no 


142  PSYCHIC   TREATMENT 

reason  to  see  in  this  any  physiological  reverberation,  such  as 
the  stimulation  of  one  sense  leading  to  the  functioning  of 
another.  It  is  by  the  psychic  way,  by  vague  reminiscences 
and  association  of  ideas  that  these  syntheses  are  established. 
Moreover,  one  only  sees  them  in  certain  subjects  preoccupied 
with  psycho-physiological  problems,  such  as  neurotic  artists, 
who  cultivate  their  temperament  with  the  greatest  care,  or  in 
very  young  people,  who  are  always  eminently  suggestible. 

The  role  of  the  idea  appears  very  distinctly  when  we  come 
to  look  at  the  influence  of  foods.  Without  doubt  what  we  take 
into  our  body  has  an  undeniable  action  upon  it.  I  would  take 
very  good  care  not  to  lay  everything  to  the  imagination;  and 
I  even  think  that  we  hardly  give  credit  enough  to  this  action 
of  the  alimentary  regime,  especially  where  it  is  a  question  of 
long-continued  habit.  What  one  does  every  day  in  the  year  is 
found  multiplied  as  a  total  at  the  end  of  the  year. 

Nevertheless,  if  one  leaves  out  of  the  question  the  more  or 
less  toxic  substances,  alcohol,  tea,  coffee,  and  tobacco,  the  abuse 
of  which  would  lead  to  disorders,  if  one  excepts  certain  foods 
recognized  by  everybody  as  being  difficult  to  digest,  our  phy- 
sical well-being  seems  to  depend  very  little  upon  alimentation. 
The  human  organism  finds  in  very  different  foods,  on  the  table 
of  the  poor  man  as  well  as  on  that  of  the  rich  man,  the  nutri- 
tive elements  of  which  it  stands  in  need.  Decidedly  the  pre- 
cautions of  neuropaths  on  this  subject  are  exaggerated.  They 
live  imbued  with  autosuggestions  which  they  have  created 
themselves.  And  in  addition  to  all  this,  there  are  physicians 
who  have  so  little  knowledge  of  the  mentality  of  nervous 
people  that  they  seem  to  devote  themselves  to  the  task  of 
making  them  still  more  miserable.  They  prescribe  for  them 
severe  regimes  which  are  annoying  in  themselves,  in  that  they 
favor  constipation  and  malnutrition,  which  are  especially  dis- 
astrous because  they  contribute  to  the  development  of  a  hypo- 
chondriacal  tendency. 

It  is  just  the  opposite  which  is  needed,  and  the  physician 
has  no  more  interesting  nor  easy  undertaking  than  the  gradual 
destruction  of  this  agglomeration  of  fears  and  theories.  It  is 
sometimes  difficult  to  disentangle  the  skein  of  these  autosug- 


OF  NERVOUS   DISORDERS          143 

gestions,  to  enter  into  the  idiosyncrasies — these  must  be  sup- 
pressed as  much  as  possible — and  to  follow  out  the  mental 
mechanism  by  which  the  patient  has  come  to  have  fixed  ideas 
which  stand  in  the  way  of  his  resuming  a  normal  life. 

Nevertheless,  this  is  the  most  pressing  duty  for  the  phy- 
sician who  is  interested  in  neuropathic  patients. 

A  nervous  patient  is  not  cured,  even  when  a  physical  treat- 
ment has  led  to  great  improvement,  if  he  preserves  his  phobic 
mentality  and  his  false  views  on  the  relations  of  cause  and 
effect,  and  if  he  continues  to  live  the  life  of  a  valetudinarian, 
always  on  the  lookout  to  avoid  influences  which  he  wrongly 
considers  hurtful.  He  remains  an  invalid  just  as  long  as  he 
is  cowardly  and  restless.  The  physician  must  first  rid  him  of 
his  foolish  fears,  and  then  lead  him  back  to  a  healthy  life. 

The  physiologist  and  the  experimenter,  who  want  to  study 
true  sensibility,  must  force  themselves  to  cast  out  all  suggest- 
ive influences ;  it  is  necessary  that  the  subject  should  be,  as  it 
were,  in  a  neuter  state,  free  from  preconceived  ideas,  but  these 
conditions  are  difficult  to  obtain. 

The  physician,  on  the  contrary,  ought  to  study  these  effects 
of  suggestion.  It  is  necessary  that  he  should  be  a  psycholo- 
gist or  a  physiognomist  to  discover  the  role  that  they  play  in  the 
sensibilities  of  his  patient.  It  is  necessary  for  him  to  know  the 
mentality  of  the  latter  in  order  to  lead  him  by  the  clearness 
of  his  instructions  to  correct  views  and  to  deliver  him  from 
the  yoke  of  his  mental  representations. 

Often  patients  do  not  at  the  outset  understand  these  coun- 
sels, and  fear  that  all  their  sensations  are  going  to  be  put  down 
as  imaginary.  They  frequently  protest  and  give  examples  of 
something  which  has  influenced  them  without  any  mental  ele- 
ment. I  accept  these  just  objections,  but  I  add :  "  Yes,  every- 
thing really  acts  more  or  less  upon  us  by  the  bodily  way;  but 
when  our  autosuggestions  are  along  the  same  line  the  action 
is  multiplied ;  when  they  are  opposed  to  it,  they  are  divided." 


144  PSYCHIC  TREATMENT 


CHAPTER   XII 

The  Emotions— Physiological  Theory;  Lang'e,  W.  James,  Sergi— Intel- 
lectualist  Theory — Cold,  Intellectual  Ideas  ;  Warm  Feelings — Sub- 
conscious Emotions;  Apparent  Automatism  of  the  Emotional  Reac- 
tion— Psychic  Origin  of  Emotion :  Value  of  this  Conception  for 
Treatment— Irrationalism  of  Nervous  Patients — Physical.  Intellectual, 
and  Emotional  Fatigue ;  Dangers  of  the  Last — Unhealthy  Impression- 
ability— Temperament  and  Character 

IT  only  now  remains  for  me  to  speak  of  exaggerated 
emotionalism — this  last  stigma  of  psychoneuroses.  Here  again 
the  subject  of  our  study  is  sensibility,  a  sensibility  altogether 
moral. 

Everything  that  takes  place  in  the  field  of  ideas  is  of  psychic 
origin.  At  the  root  of  every  emotion  there  are  mental  rep- 
resentations and  feelings  which  determine  remote  reactions 
and  the  functioning  of  various  physiological  organs.  The 
emotion  is  psychological  and  not  physiological;  it  is  intellectual 
and  not  somatic. 

I  know  very  well  that  in  laying  down  these  premises  I  am 
not  at  all  modern.  I  do  not  ignore  the  fact  that  Lange,  W. 
James,  Sergi,  and  others,  make  emotions  physiological  proc- 
esses. According  to  them,  the  peripheral  stimulus  brings  into 
activity  the  medullary  centers,  and  determines  muscular,  vaso- 
motor,  and  visceral  reactions ;  and  the  mind,  the  sensitive  ego, 
only  experiences  the  emotion  after  the  shock  has  occurred,  con- 
fining itself,  as  it  were,  to  the  mere  recognition  of  the  physio- 
logical disorder. 

According  to  Lange,  all  emotional  movement  is  nothing  but 
a  vasomotor  reaction  directly  provoked  by  the  stimulus.  W. 
James  is  less  simplistic  in  his  philosophy,  and  assumes  a  whole 
series  of  troubles  in  the  motor,  vasomotor,  and  glandular  ap- 


OF  NERVOUS   DISORDERS         145 

paratus.  The  efnotion  felt  is,  in  short,  only  the  conscious- 
ness of  these  organic  changes ;  it  is  merely  an  epiphenomenon. 

These  authors  have  fearlessly  set  forth  their  views  in 
the  baldest  manner.  They  say :  "  Here  is  a  mother  who  is 
mourning  for  her  son.  General  opinion  assumes  three  steps  in 
the  production  of  the  phenomenon:  I.  A  perception  or  an 
idea.  2.  An  emotion.  3.  The  expression  of  this  emotion. 
This  order  is  wrong;  the  two  latter  terms  should  be  reversed, 
and  the  argument  proceed  as  follows: 

"  i.  This  woman  has  just  heard  of  the  death  of  her  son. 
2.  She  is  prostrated  (physiologically).  3.  She  is  sad.  Now 
what  does  her  sadness  consist  in?  Simply  the  more  or  less 
vague  consciousness  of  vascular  phenomena,  which  are  taking 
place  in  her  body,  and  of  all  their  consequences." 

W.  James  is  quite  as  explicit,  and  says :  "  We  lose  our 
fortune:  we  are  afflicted,  and  we  weep;  we  meet  a  bear:  we 
are  afraid,  and  we  run  away ;  a  rival  insults  us :  we  get  into  a 
rage,  and  we  fight — this  is  what  common  sense  says.  The 
hypothesis  that  we  are  here  going  to  defend  implies  that  this 
order  of  succession  is  inexact;  that  one  mental  state  is  not 
directly  brought  about  by  another;  that  bodily  manifestations 
must  first  be  interposed  between  them;  and  that  the  most 
rational  assertion  is  that  we  are  afflicted  because  we  weep, 
angry  because  we  fight,  and  frightened  because  we  tremble." 

Such  strange  statements  as  these  must  find  contradictors, 
and  Nahlowsky,  Wundt,  Worcester,  Irons,  Lehmann,  and 
others,  have  brought  the  intellectual  theory  in  opposition  to 
the  physiological  theory. 

The  more  one  tries  to  get  to  the  bottom  of  these  discussions 
the  more  bizarre  do  they  appear,  and  I  can  not  in  these  lectures 
attempt  to  criticize  each  one  of  the  arguments  put  forth  by 
both  parties  in  the  controversy. 

But  as  emotion  plays  an  important  role  in  the  development 
of  psychoneuroses,  I  will  try  to  explain  the  way  in  which  I 
regard  the  emotions.  Common  sense  is  right :  the  woman  who 
has  just  lost  her  child  has  first  of  all  a  perception,  an  idea; 
this  idea  saddens  her,  and  her  sorrow  is  shown  by  tears.  All 
this  emotional  movement,  which  we  call  sorrow,  has  begun 


146  PSYCHIC   TREATMENT 

with  a  phenomenon  that  is  peripheral  in  its  origin;  by  sensa- 
tions, as  is  the  case  with  all  phenomena  of  mentality.  Our 
mental  representations  and  our  ideas  are  always  awakened  by 
peripheral  stimuli.  It  is  our  five  senses  which  inform  us  con- 
cerning practically  all  that  goes  on  around  us,  and  it  is  the 
sensations  that  are  felt  which  give  birth  to  the  idea. 

The  news  of  the  death  has  been  transmitted  to  the  mother 
by  words  or  by  writing;  it  is  in  this  way  that  the  initial  cen- 
tripetal transfer  has  taken  place  which  awakens  the  mental 
representation  of  death.  But  here  we  are  already  in  the 
presence  of  an  irreducible  psychological  phenomenon.  If  we 
try  to  explain  it  physiologically  we  have  to  attack  the  problem 
of  the  mind,  and  to  show  how  a  cortical  cellular  vibration, 
provoked  by  the  sensory  stimulus,  can  be  transformed  into  a 
thought,  into  the  mental  image  of  death.  Such  an  attempt 
seems  to  me  premature,  at  least. 

The  same  considerations  apply  to  the  feeling  which  follows 
this  mental  representation,  to  the  sorrow  which  it  begets.  It 
has  its  source  in  the  mentality  of  the  subject.  There  are  some 
mothers  who  will  not  shed  a  tear,  others  in  whom  the  emotion 
will  be  shown  in  a  wholly  different  manner — by  pallor,  or  faint- 
ing, or  by  an  hysterical  attack. 

The  origin  of  all  this  disorder  is  wholly  psychic  and  moral, 
and  I  do  not  see  why  sorrow,  inasmuch  as  it  is  a  psychic  phe- 
nomenon, should  not  follow  the  idea  of  death. 

The  partisans  of  the  physiological  theory  refuse  to  the 
"  ego  "  the  faculty  of  perceiving  an  emotion  that  is  wholly 
psychic ;  they  want  the  emotion  to  be  made  up  of  a  combination 
of  organic  sensations.  I  do  not  see  how  that  could  simplify 
the  problem.  How  can  our  vague  recognition  of  the  fact  that 
we  have  tears  in  our  eyes,  of  palpitations  and  faintness,  be 
transformed  into  a  sensation,  quite  sui  generis,  which  is  called 
sorrow?  Why  do  we  not  experience  it,  at  least  in  a  slight 
degree,  when  a  dense  smoke  makes  our  tears  flow  and  hinders 
our  respirations  ?  Why  have  we  no  feeling  of  shame  when  the 
inhalation  of  nitrite  of  amyl  makes  us  blush  scarlet  ?  Emotion 
is,  first  of  all,  a  psychic  condition.  The  initial  mental  repre- 
sentation, called  forth  by  the  peripheral  stimuli,  awakens  asso- 


OF  NERVOUS   DISORDERS          147 

ciations  which  always  vary  according  to  the  actual  mentality, 
whether  native  or  acquired,  of  the  subject.  This  is  why  the 
reaction  varies  from  one  individual  to  another,  and  in  the 
same  person,  according  to  the  feelings  of  the  moment. 

The  idea  which  is  at  first  simply  cognitive,  intellectual,  and 
cold,  becomes  a  feeling,  a  psychic  emotion.  Ask  me  why  and 
how,  and  I  will  tell  you:  I  do  not  know.  It  is  begging  the 
question  to  say:  Because  it  wakens  feelings  of  fear,  or  sor- 
row, or  anger. 

Man  is  so  made  that  he  has  feelings,  just  as  he  has  ideas, 
or,  rather,  he  has  in  his  head  only  ideas,  some  purely  intellec- 
tual, which  do  not  stir  him,  others  which  awaken  a  series  of 
associations  of  ideas  and  profoundly  disturb  him. 

When  we  dwell  on  any  subject  whatsoever  we  form  an 
opinion.  This  intellectual  work,  however  intense  it  may  be, 
is  free  from  emotion.  Suddenly  an  association  of  ideas  wells 
up ;  we  see  at  a  glance  that  to  express  a  certain  opinion  would 
anger  a  rival,  and  lead  him  into  a  discussion.  We  are  in  the 
presence  of  danger,  and  immediately  we  experience  a  whole 
series  of  feelings.  They  are  such  feelings  as  might  be  accom- 
panied by  tears,  heart  beats,  and  gestures  which  let  loose  the 
emotional  storm. 

Undoubtedly,  if  this  latter  state  of  affairs  is  totally  lacking, 
if  there  is  not  the  slightest  physiological  disorder,  then  emotion 
is  lacking.  The  partisans  of  the  physiological  theory  argue 
from  this  fact,  in  order  to  give  the  greatest  importance  to  these 
organic  reactions.  But  it  is  not  because  we  have  not  felt  our 
tears  and  experienced  our  palpitations  that  the  emotion  is 
absent;  it  is,  on  the  contrary,  because  we  have  not  been  psy- 
chically moved  that  our  eyes  have  remained  dry  and  that  our 
heart  has  preserved  its  normal  rhythm.  I  grant  that  the  vague 
experience  of  these  organic  disorders  that  occur  so  quickly 
can  react  in  its  turn  on  our  ego  and  contribute  to  the  rein- 
forcement of  the  psychic  emotion,  but  I  hold  that  it  is  a  sec- 
ondary phenomenon. 

I  am  astonished  that  the  innovators  of  whom  I  have  spoken 
have  expressed  their  theory  with  so  little  circumspection.  If 
they  had  simply  said,  the  emotion  of  which  the  subject  is  con- 


148 

scious,  as  well  as  that  which  others  detect  in  him,  is  in  part 
due  to  the  vague  experience  of  physiological  reactions  that  are 
set  going  by  the  emotional  idea,  nobody  would  think  of  pro- 
testing. But  it  is  going  quite  too  far  to  say  that  the  emotion 
is  nothing  but  the  result  of  this  experience. 

In  the  last  analysis  man  experiences  emotions.  This  ulti- 
mate phenomenon  is  psychic  and  irreducible.  Why  should  it 
occur  more  easily  because  we  have  vaguely  noticed  our  heart 
beats  and  the  tears  in  our  eyes?  Why  should  it  not  follow 
directly,  as  one  idea  follows  another,  the  mental  representation 
of  the  death  of  some  one  we  love?  To  pretend  that  we  weep 
first,  and  that  we  are  moved  afterward,  is,  as  our  authors 
naively  acknowledge,  to  wound  common  sense,  the  guiding 
quality  of  intelligence. 

The  first  characteristic  of  emotion  is,  to  my  mind,  its  ideo- 
genic  origin.  Then  follows  the  irradiation  of  the  stimulus 
to  other  centers,  the  wakening  of  previous  mental  repre- 
sentations that  are  instinctive  or  acquired,  creating  psychic 
emotion.  Then  follow  the  physiological  manifestations  of  the 
mental  condition  in  the  form  of  actions,  which  are  always 
consecutive  to  the  idea. 

These  physiological  reactions  can  not  have  taken  place 
without  a  new  centripetal  rush  of  sensations,  which  may,  in 
their  turn,  become  distressing.  They  reinforce  the  psychic 
emotion;  they  may  occur  even  when  we  have  already  gotten 
over  the  effect  of  the  fact  which  started  the  first  emotion. 
New  emotions  may  result  from  them,  such  as  that  of  the  shame 
or  vexation  which  we  experience  from  having  let  ourselves  be 
ruled  by  fear  or  anger.  This  whole  succession  of  feelings 
constitutes  our  psychic  life,  and  it  is  ridiculous  to  try  to  explain 
it  all  by  vasomotor  reactions. 

But,  it  may  be  said,  certain  emotional  movements  occur 
without  the  participation  of  the  idea,  and  with  such  rapidity  that 
one  would  be  tempted  to  see  in  them  merely  a  simple  bulbar 
function,  which,  independent  of  the  thinking  ego,  dwells  in  the 
higher  parts  of  the  brain. 

In  short,  this  is  what  occurs  in  fear  under  all  its  forms, 
from  timidity  to  terror.  Fear  is  common  to  all  animals,  even 


OF   NERVOUS    DISORDERS          149 

the  lowest,  to  which  we  can  ascribe  only  a  very  limited  psychic 
life. 

This  springs  from  the  fact  that  fear,  within  certain  limits, 
is  an  eminently  useful  emotion.  It  is  the  cry  of  alarm  uttered 
by  sentinels  the  instant  they  perceive  the  approach  of  danger. 
The  psychic  emotion  takes  hold  of  the  guard-house,  and  clears 
it  for  action  by  virtue  of  its  motor  reactions.  These  are  the 
last  manifestations  of  which  the  lookers-on  are  conscious,  and 
which,  perceived  at  the  same  time  by  the  soldiers,  are  bound 
to  stir  up  in  them  more  agitation  and  add  still  further  to 
their  excitement. 

This  sensibility,  this  active  emotion  of  fear,  is  so  neces- 
sary for  the  defense  of  the  organism  that  it  has  become  so 
mechanical  that  it  seems  as  tho  it  might  be  confined  to  the 
medullary  centers,  or  lower  brain  areas,  without  passing 
through  the  thinking  ego.  This  would  be  an  economy  of 
time,  but  this  active  emotion  still  remains  so  closely  connected 
with  mental  representation  that  it  ceases  immediately  in  man 
and  in  a  higher  animal  from  the  moment  they  recognize  the 
foolishness  of  their  fears.  The  child  has  no  longer  any  emo- 
tion when  he  finally  recognizes  his  brother,  in  some  disguise 
which  has  frightened  him,  or  when  he  sees  his  friend  playing 
quietly  with  a  dog  of  which  he  has  been  afraid.  He  does  not 
fear  to  go  into  a  room  because  it  is  dark,  but  because  he  has 
a  mental  representation  of  danger.  He  is  afraid,  and  tries  to 
save  himself. 

The  repetition  of  an  emotional  movement  facilitates  its 
automatic  reproduction,  and  the  more  the  reaction  is  estab- 
lished in  the  lower  centers  the  more  it  escapes  from  the  con- 
trol of  the  psychic  ego.  It  is  a  little  like  what  goes  on  in  a 
factory,  where  the  director  at  first  knows  all  about  everything, 
even  to  the  least  important  details.  Little  by  little  he  ceases 
to  interest  himself  in  these,  and  gives  up  certain  cares  to  his 
faithful  employees.  He  almost  forgets  that  they  are  being 
attended  to,  but,  nevertheless,  he  has  not  abdicated ;  it  is  always 
he  who  directs  affairs. 

One  may,  in  some  cases,  clearly  detect  this  transformation 
of  the  psychic  emotion  into  a  phenomenon  that  appears  to  be 


150  PSYCHIC   TREATMENT 

purely  reflex.  A  physician  whom  I  attended  was  suffering 
from  depression,  in  which  he  was  overwhelmed  by  fears  on 
the  subject  of  his  position  in  the  future.  He  would  experience 
keen  emotion  on  opening  the  daily  paper  in  which  he  expected 
to  find  important  news.  At  such  times  he  was  aware  of 
a  trembling  in  his  lower  limbs.  This  emotion  recurred  every 
day  for  some  weeks.  Little  by  little,  however,  calmer  reflec- 
tions intervened ;  the  patient  could  read  his  paper  quietly,  even 
while  looking  for  the  news  which  interested  him.  "  It  is 
curious,"  said  he  to  me  one  day,  "  I  am  no  longer  conscious 
of  any  psychic  emotion;  it  seems  to  me  that  I  have  conquered 
myself,  and  that  I  have  become  indifferent  to  that  question. 
which  troubled  me  so.  Nevertheless,  the  moment  the  paper 
is  brought  to  me,  I  immediately  feel  the  trembling  in  my  legs !" 

The  psychic  emotion  was  certainly  still  there.  The  news- 
paper had  no  more  to  do  with  it  than  so  many  sheets  of  paper. 
He  could  be  moved  only  by  the  mental  representation  of  what 
he  was  going  to  learn.  The  emotion  was  still  ideogenic,  but 
it  had  passed  so  often  along  the  same  channel  that  the  ego 
had  lost  interest  in  it,  and  it  was  left  to  act  upon  the  lower 
centers.  In  such  a  case  it  is  only  a  sort  of  distraction  of  the 
thinking  ego. 

The  young  pianist  strikes  the  notes  consciously  and  with 
effort,  and  his  playing  is  slow.  He  only  plays  easily  when 
the  ego  is  dissociated  from  this  mechanism,  and  relegates  to 
the  spinal  cord  and  to  the  medulla  the  ta'sk  of  securing  this 
automatism. 

If,  then,  by  individual  habit  or  racial  instinct,  the  emotion 
of  fear  can  become  subconscious  and  limited  to  a  medullary 
mechanism  or  to  lower  cerebral  centers,  it  is  no  less  clear  that 
it  is  always  ideogenic  in  its  essence,  since  it  is  necessary  to 
have  a  more  or  less  distinct  idea  of  danger  to  produce  it.  Sup- 
press the  idea  of  danger  and  the  feeling  of  fear  which  is  con- 
nected with  it,  and  you  will  surely  cut  short  an  emotional 
movement. 

These  considerations  have  not  only  the  interest  which  at- 
taches to  all  psychologic  study,  they  are  of  great  importance 
in  the  treatment  of  nervousness.  Patients  have  only  too  ready 


OF  NERVOUS   DISORDERS          151 

a  physiological  conception  of  emotion,  and  are  tempted  to 
consider  it  as  a  somatic  reaction  of  their  nerves.  They  forget 
that  a  perception  only  produces  an  emotion  when  it  awakens 
the  association  of  disturbing  ideas.  The  impressionability  of 
the  subject  is  mental ;  it  may  be  diminished  by  education. 

Nervous  patients  show  to  an  extreme  degree  this  exag- 
gerated emotional  tendency,  which  renders  them  incapable  of 
bearing  what  life  brings  to  them.  The  slightest  happenings 
are  catastrophies  for  them,  the  smallest  failure  discourages 
them.  They  are  not  content  with  magnifying  the  obstacles 
which  rise  before  them,  and  drawing  back  at  the  sight  of 
these ;  they  create  emotions,  in  themselves  very  real,  alas !  but 
excited  by  the  imagination.  They  are  overcome  by  a  telegram 
without  having  learned  its  contents;  they  read  between  the 
lines  of  a  letter,  and  ascribe  to  any  occurrence  whatever  the 
least  probable  and  the  most  terrible  causes. 

I  am  struck,  in  the  case  of  my  own  patients,  with  this 
inability  to  see  things  clearly,  to  classify,  according  to  the 
order  of  probability,  the  suppositions  that  they  can  make.  An 
expected  letter  has  not  come.  Very  well ;  they  do  not  stop  to 
think  that  the  time  that  has  elapsed  is  too  short  to  permit  of 
a  reply,  or  that  there  could  have  been  some  fortuitous  delay 
of  no  importance.  No;  the  mind  jumps,  without  any  hesita- 
tion, to  the  most  alarming  and  the  least  possible  hypothesis.  I 
have  no  reply,  therefore  the  person  is  sick;  others  do  not 
hesitate  to  say,  dead,  and  the  emotional  storm  is  let  loose. 

Many  persons  allow  themselves  to  be  impressed  by  all  the 
sensations  that  they  experience.  Some  functional  disorder 
which  would  leave  a  well-balanced  person  wholly  indifferent 
strikes  them  with  fear.  If  they  have  a  palpitation  of  the 
heart,  they  immediately  dread  imminent  syncope;  a  sensation 
of  vertigo  makes  them  fear  for  their  head.  They  are  afraid 
of  all  diseases ;  they  are  often  even  afraid  of  fear.  This  is  so 
frequent  that  physicians  have  invented  the  term  phobophobia. 

It  is  the  subject  himself  who  thus  calls  forth  the  specters 
which  terrify  him;  and  we  recognize  in  it  that  human  sug- 
gestibility, that  credulity,  which  reinforces,  even  creates,  our 
sensations,  and  causes,  by  simple  conviction,  whether  accom- 


152  PSYCHIC  TREATMENT 

panied  by  emotion  or  not,  functional  troubles,  and  reactions 
that  may  be  sensory,  motor,  vasomotor,  glandular,  or  trophic. 

I  have  said  that  this  suggestibility,  which  magnifies  fatigue, 
increases  our  sensations  tenfold,  and  forms  the  constant  basis 
of  our  emotions,  is  exaggerated  in  patients  suffering  from  the 
psychoneuroses.  This  is  true  if  one  compares  the  reaction 
of  a  sick  person  with  that  of  a  healthy  man  undergoing  the 
same  effort,  or  sensation,  and  the  same  emotion;  and  not  a 
day  passes  but  what  the  physician  can  and  should  show  his 
patient  how  much  these  reactions  overstep  the  normal  limit. 

But  in  looking  at  the  question  of  suggestibility  in  a  more 
general  way,  I  have  a  feeling  of  very  kindly  indulgence  for 
nervous  people,  and  I  find  them  more  excusable  than  the  well 
man.  Just  think!  The  majority  of  men  are  so  suggestible 
and  so  credulous  and — let  us  say  it  right  out — such  ninnies  as 
to  succumb,  in  a  few  seconds,  in  broad  daylight,  to  the  sug- 
gestion of  sleep,  and  this  at  a  time  when  they  have  not  the 
slightest  need  of  rest.  We  see  them  under  the  influence  of 
the  suggester  turning  into  regular  puppets :  they  become  cata- 
leptic; their  skin,  and  even  their  viscera,  become  insensible; 
a  doubling  of  their  personality  may  be  produced;  they  are 
made  delirious.  Think  of  the  superstition  which  still  reigns 
in  all  social  strata,  and  the  difficulty  which  the  majority  of 
people  experience  in  overcoming  their  fears  by  calm  good 
sense. 

Is  there  any  reason  to  be  astonished  if  nervous  patients 
believe  in  the  reality  of  their  sensations ;  that  is  to  say,  if  they 
experience  no  doubt  concerning  the  relations  of  cause  and 
effect,  which  they  have  established  often  after  a  series  of 
prolonged  experiments,  between  two  successive  phenomena? 

It  is  always  irrationalism,  or  the  absence  of  a  critical 
spirit,  which  encourages  us  in  error.  That  malicious  hobgob- 
lin, autosuggestion,  becomes  a  part  of  our  life  and  works 
mischief  with  our  days. 

There  are  no  moments  of  our  life  when  we  may  be  sure 
of  escaping  from  this  slavery  to  our  mental  representations. 
Bernheim  has  very  well  said :  "  Not  everything  is  suggestion 


OF  NERVOUS    DISORDERS          153 

in  this  world,  as  I  have  been  told,  but  there  is  suggestion  in 
everything." 

If  one  has  really  grasped  the  power  of  the  idea,  it  will  be 
seen  that  of  the  four  mental  stigmata  which  I  have  attributed 
to  the  psychoneuroses,  suggestibility  forms  the  most  marked 
defect.  This  it  is  which  exaggerates  the  tendency  to  fatigue, 
the  sensibility,  and  the  emotions.  It  is  this  credulity,  this 
facility  in  receiving  impressions,  of  believing  that  it  has  hap- 
pened, that  characterizes  nervous  people.  Their  irrationality 
is  a  mental  weakness  which,  even  when  not  due  to  ignorance, 
in  which  case  it  is  pardonable,  may  coexist  with  marked  in- 
telligence. Do  not  let  us  be  too  lavish  with  our  reproaches 
of  the  follies  of  others,  but  let  us  remember  our  own  weaknesses. 

But  if  I  assign  to  autosuggestion  so  important  a  part  in  the 
development  of  nervous  symptoms  I  do  not  forget  that  there 
are  no  mental  manifestations  without  cerebral  work,  and  I 
attribute  a  great  influence  to  the  true  fatigue  which  follows 
all  emotions. 

The  nervous  patient  is,  in  fact,  in  a  vicious  circle.  His 
mental  condition  makes  him  subject  to  magnified  and  multi- 
plied impressions.  The  result  is  a  greater  fatigue,  which  pro- 
ceeds to  exaggerate  still  further  his  mental  impressionability. 

Do  not  let  us  forget  that  fatigue  acts  on  the  mental  dispo- 
sition ;  that  it  creates  pessimistic  states  of  mind ;  and  that,  no 
matter  what  its  source  may  be. 

Fatigue  may  be  due  to  three  causes.  It  may  result  from 
physical  exercise.  As  a  rule,  this  fatigue  is  not  dangerous, 
and  it  has  to  be  pushed  to  such  an  extreme  as  to  result  in 
exhaustion  before  it  gives  rise  to  those  psychopathic  states 
which  are  indicated  by  Tissie  and  Fere.  It  is  healthy,  this 
genuine  physical  fatigue;  it  makes  the  heart  beat  more  ener- 
getically; it  accelerates  respiration,  oxygenation  of  the  blood, 
and  transpiration.  It  favors  organic  depuration.  And,  in 
short,  with  all  these  advantages,  it  is  not  to  be  feared,  be- 
cause, laziness  being  natural,  we  stop  working  a  long  time 
before  it  could  possibly  be  hurtful.  Athletics  are  also  to  be 
recomnaended,  altho  their  value  may  have  been  exaggerated. 

Fatigue  caused  by  intellectual  work  is  less  hygienic.     In- 


154  PSYCHIC   TREATMENT 

tellectual  work  demands  a  sedentary  life  and  a  sitting  posture ; 
it  chills  the  extremities  by  bringing  the  blood  to  the  head. 
This  mental  activity  is  necessary  and  useful  for  our  intellec- 
tual and  moral  development.  We  ought  to  be  men  and  not 
athletes,  and  our  superiority  should  be  mental  in  its  nature. 
Here,  again,  what  saves  us  is  our  pure  laziness ;  it  hinders  us 
more  often  from  being  dangerously  overdriven,  and,  for  my 
part,  I  have  not  yet  seen  any  nervous  patients  who  can  at- 
tribute their  condition  to  simple  intellectual  overwork.  In 
short,  as  Madame  Schwetchine  has  well  said,  work  is  the 
thing  that  fatigues  us  the  least. 

Nevertheless,  as  Dejerine *  remarks,  intellectual  work  plays 
havoc  with  us  when  it  is  accompanied  by  worry. 

Then  there  is  an  emotional  and  passionate  element  con- 
nected with  it,  and  it  is  in  this  emotion  that  we  must  recognize 
the  most  serious  cause  of  nervous  fatigue.  Such  fatigue  has 
no  advantages ;  it  is  never  useful.  It  is  harmful  in  the  highest 
degree,  and  it  is  that  from  which  we  most  often  suffer. 

Naturally  it  is  impossible  for  us  completely  and  persist- 
ently to  avoid  this  emotional  fatigue.  We  must  undergo  in 
life  certain  misfortunes  and  very  keen  annoyances,  which  we 
can  only  meet  with  imperturbable  stoicism.  But  catastrophies 
do  not  happen  every  day;  however  unfortunate  one  may  be, 
there  are  some  moments  of  respite  which  allow  the  organism 
to  recover  its  strength. 

But  imagine  what  happens  when  the  subject  is  endowed 
by  nature  and  education  with  a  sickly  impressionability,  when 
he  is  morally  so  thin  skinned  that  he  feels  pain  from  the 
slightest  graze. 

In  this  state  of  moral  hyperesthesia  he  is  swept  by  his 
emotions  every  day;  he  is  loaded  by  misfortunes  which,  altho 
they  be  imaginary,  have,  none  the  less,  the  unpleasant  conse- 
quences of  emotional  outbreaks. 

An  emotion  tires  the  organism,  and  particularly  the  ner- 
vous system,  more  than  the  most  intense  physical  or  intellec- 
tual work. 


1  L'hiriditt  dans  la  maladies  due  systtmnerveux.    Paris,  1886. 


OF  NERVOUS   DISORDERS          155 

Terror  or  anger  is  enough  to  provoke  a  stroke  of  apoplexy ; 
to  lead  to  syncope ;  to  paralyze  the  limbs ;  to  bring  on  an  attack 
of  madness.  Simple  ill  humor,  caused  by  those  who  surround 
us,  can  take  away  all  our  enthusiasm  and  our  energy.  And 
let  us  note  the  fact  that  if  the  conduct  of  others  has  been  the 
cause  of  our  emotion,  it  is  really  we  ourselves  who  have  cre- 
ated it  by  the  manner  in  which  we  have  reacted. 

On  the  other  hand,  a  pleasant  word,  a  reconciliation,  an 
optimistic  reflection,  can  give  us  strength.  But,  however  rap- 
idly we  may  get  over  our  ill  humor,  we  can  not  help  but  feel 
that  the  psychic  and  organic  disturbance  which  we  have  al- 
lowed to  sweep  over  us  has  been  profound. 

It  seems  to  me  that,  under  the  influence  of  the  absurd 
Cartesian  dualism,  the  body  and  the  soul  have  been  placed 
altogether  too  much  in  opposition.  We  must  get  back  to  a 
more  complete  monism.  There  are  no  somatic  phenomena, 
however  slight  they  may  be,  that  have  no  influence  on  our 
mentality ;  and,  above  all,  there  is  no  movement  of  the  mind 
without  its  echo  on  the  organism. 

We  are  only  able  to  detect  in  ourselves  and  in  others  the 
most  obvious  phenomena.  Moreover,  we  see  emotions  that 
are  wholly  diverse  expressed  by  the  identical  phenomena  of 
blushing,  growing  pale,  or  by  ordinary  gestures.  We  see 
tears  accompanying  smiles  as  well  as  sobs.  These  are  gross, 
macroscopic  reactions.  But  there  are  more  delicate  and  less 
perceptible  phenomena,  which,  under  the  influence  of  an  idea, 
present  themselves  within  the  very  tissues  themselves.  It  is 
this  microscopic  psychophysiology  that  should  be  studied  in 
mental  pathology. 

If  we  can,  by  a  healthy  philosophy  of  life  and  by  moral 
hygiene,  suppress  this  toxic  element  of  emotion,  we  shall  rid 
the  greatest  physical  and  intellectual  fatigue  of  its  harmful 
influence. 

In  all  my  patients  I  have  detected  the  influence  of  emotions, 
of  worry,  and  of  passionate  outbreaks.  I  have  everywhere 
been  able  to  see  that  the  original  cause  of  the  trouble  lies  in 
the  native  mentality  of  the  subject,  and  in  those  peculiarities 
of  his  character  which  have  not  been  sufficiently  overcome  by 


156  PSYCHIC  TREATMENT 

clear  and  reasonable  convictions.  I  can  not  treat  my  patients 
without  having  recourse  to  psychotherapy. 

Moreover,  the  patients  themselves  have  no  difficulty  in  rec- 
ognizing these  truths,  but  they  obstinately  excuse  their  con- 
dition by  arguing  the  impossibility  of  changing  their  tempera- 
ment. Their  habitual  reply  is :  "  It  is  stronger  than  I ;  I  have 
always  been  like  this." 

Yes,  I  know  it;  we  preserve  our  temperament  throughout 
our  whole  life,  just  as  we  keep  our  physical  blemishes;  but 
we  can  modify  it  greatly  by  educating  ourselves.  Our  phys- 
ical deformities  are  often  definite,  but  our  mentality  is  always 
malleable.  It  is  our  duty  to  transform  our  inner  tempera- 
ment into  an  acquired  character.  This  task  devolves  upon 
all  of  us,  whether  we  are  sick  or  welL 


OF  NERVOUS   DISORDERS          157 


CHAPTER   XIII 

Piy chasthenia :  Congenital  and  Not  Acquired — Absence  of  Any  Dividing 
Line  Between  the  Normal  Mental  Condition  and  Insanity — Clinical 
Forms  of  Psychoneuroses — Neurasthenia:  Its  Characteristic  Stigmata  : 
Physical,  Intellectual,  and  Moral  Fatigability — Exaggeration  ;  Signifi- 
cant Contradictions — Mental  Instability — Somatic  Symptoms  Due  to 
Fatigue 

I  HAVE  shown  that  in  nervous  patients  there  are  found 
certain  mental  peculiarities  which,  by  reason  of  their  constancy, 
may  be  called  stigmata.  This  mental  state  is  not  secondary 
and  dependent  upon  various  functional  disturbances  of  the 
organs  of  vegetative  life,  as  has  been  too  often  believed.  The 
mental  defect  is,  on  the  contrary,  primary,  and  it  is  by  means 
of  mental  representations  and  autosuggestions,  giving  rise  to 
emotional  outbreaks,  that  the  subject  creates  numerous  func- 
tional disorders,  and  nurses  them  along,  or  aggravates  them. 
These  stigmata  are  the  index  of  weakness,  and,  as  I  have  said, 
the  psychoneuroses  should  by  right  be  placed  on  the  list  of  the 
psychopathies. 

This  psychasthenia  is  always  congenital  by  virtue  of  that 
heredity  which  outlines  the  characteristics  of  our  brain,  and, 
from  this  point  of  view,  we  have  no  reason  to  look  for  ac- 
quired psychoneuroses,  occasioned,  more  or  less  suddenly,  by 
overwork,  emotions,  traumatisms,  or  slow  deterioration  in  the 
organs,  brought  about  either  by  diathetie  tendencies  or  by 
intoxications. 

Unquestionably  we  often  see  sick  people  who  tell  us  that 
they  once  enjoyed  good  health,  and  trace  the  beginning  of 
their  illness  back  to  a  certain  date.  But  if  we  take  the  trouble, 
by  lengthy  and  frequent  conversations,  to  scrutinize  the  mental 
past  of  these  patients,  and  to  analyze  their  previous  state  of 
mind,  we  find  no  difficulty  in  recognizing  that,  long  before  the 


158  PSYCHIC  TREATMENT 

development  of  the  actual  trouble,  the  mental  stigmata  of 
neuroses  were  traceable,  and  the  event  that  brought  on  the 
acute  symptoms  was  only  the  drop  of  water  that  made  the 
vessel  overflow. 

Sometimes  the  troubles  of  which  one  learns  the  existence 
in  the  past  are  actually  functional :  the  patient  has  had  head- 
aches ;  has  been  obliged  to  stop  studying ;  he  has  had  dyspeptic 
symptoms  and  symptoms  of  enteritis,  or  he  has  had  a  tendency 
to  insomnia.  In  many  of  these  subjects  one  detects  an  abnor- 
mal sensibility,  a  tendency  to  tears,  or  else  a  precocious  develop- 
ment of  sexual  instincts  from  the  earliest  years  of  childhood. 
Often,  after  having  first  said  that  he  has  always  enjoyed  good 
health,  the  patient  will  admit  that  he  has  had  a  characteristic 
attack  of  nervousness  or  of  neurasthenia,  which,  on  account 
of  being  absorbed  in  his  present  trouble,  he  had  forgotten  to 
mention.  But  above  all,  while  gaining  a  knowledge  of  the 
personality  of  the  subject,  you  will  find  the  mental  predispo- 
sition characterized  by  a  certain  illogicalness,  by  a  tendency 
to  hasty  conclusions,  and  by  a  lack  of  judgment  which  is 
always  a  fertile  source  of  unhealthy  autosuggestions. 

The  patients  often  make  this  analysis  of  themselves  with 
more  rapidity  than  the  physician.  In  all  cases,  the  majority 
follow  with  the  greatest  ease  this  dissection  of  their  mental 
make-up,  and  conclude,  with  uneasiness :  "  Then  I  am  suffer- 
ing most  of  all  from  weakness  of  mind." 

Do  not  be  afraid  to  say  yes ;  but  do  not  make  this  acknowl- 
edgment without  further  qualifications,  for  fear  it  should  both 
hurt  and  discourage  the  patient.  He  should  know  that  all  of 
us  are,  on  some  point  or  another,  mentally  weak,  that  nobody 
can  flatter  himself  that  he  possesses  complete  mental  equilib- 
rium. We  all  have  a  fragmentary  intelligence,  and,  however 
brilliant  may  be  the  qualities  of  our  mind,  we  shall  always 
find  in  some  corner  of  our  soul  a  weakness,  a  rebellious  defect, 
against  which  our  reason  is  often  powerless. 

Between  the  conditions  which  we  call  normal  and  that  of 
confirmed  insanity  there  is  no  definite  line  of  demarcation. 
It  is  impossible  to  make  of  pathological  states  of  the  mind 
morbid  entities ;  to  classify  them,  according  to  their  symptology, 


OF  NERVOUS   DISORDERS         159 

in  distinct  compartments,  separated  one  from  another.  On  the 
contrary,  there  is  a  blending  of  tints,  as  in  a  damaged  photo- 
graph, which  shades  from  clear  white  to  the  deepest  black. 
No  one  can  aspire  to  take  his  place  in  this  pure  white 
zone  which  represents  inaccessible,  ideal  health;  we  are  all  in 
the  grayish  white  or  the  light  gray.  The  nervous  patient  who 
consults  us  may  take  comfort ;  he  is  not  so  far  from  us  as  he 
thinks.  Let  us  meet  him  half  way,  and  frankly  acknowledge 
to  him  our  weaknesses  and  our  inner  defects ;  let  us  get  nearer 
to  him.  Let  us  recognize  his  good  qualities,  and  show  them  to 
him;  let  us  teach  him  to  make  an  optimistic  inventory  of  his 
mentality.  Then  he  will  pick  up  courage;  the  specter  of  in- 
sanity, which  had  hitherto  haunted  him,  will  vanish.  He  will 
no  longer  live  in  fear,  after  it  has  been  proved,  that  his  mental 
weakness  is  only  comparative,  and  that  he  is  in  such  a  numer- 
ous and  excellent  company.  As  patients  and  physicians  we 
can  shake  hands,  for  we  have  all  a  common  task,  which  is  that 
of  recognizing  our  continual  tendency  to  weakness,  and  of 
remedying  it  by  the  persevering  cultivation  of  our  intellectual 
and  moral  ego. 

I  wish  to  especially  emphasize  this  point:  that  the  mental 
stigmata  which  I  have  enumerated  are  common  to  all  the 
psychoneuroses ;  but  there  are  in  this  class  some  distinct  clin- 
ical forms  which  admit  of  a  slightly  different  prognosis;  and 
while  we  continue  to  recognize  the  common  characteristics,  we 
ought  to  consider  separately  neurasthenia,  hysteria,  hystero- 
neurasthenia,  the  class  of  degenerates  or  unbalanced  persons, 
and,  lastly,  the  most  severe  forms  of  hypochondria  and  of  mel- 
ancholia, which  undoubtedly  encroach  upon  the  domain  of 
psychiatry,  properly  so  called. 

Neurasthenia  is  the  mildest  form  of  these  psychoneuroses. 
It  is  the  form  which  most  nearly  approaches  the  so-called 
normal  condition.  According  to  Mcebius,  it  is  the  original 
source  from  which  may  be  derived  by  further  development, 
whether  in  the  same  individual  or  in  his  descendants,  hysteria 
hypochondria,  melancholia,  and  insanity. 

I  recognize  the  fact  that  in  certain  families  we  may  actually 
trace  this  progressive  degeneracy,  and  may  often  find  neuras- 


160  PSYCHIC   TREATMENT 

thenia  in  the  genealogical  tree  of  the  insane,  or,  inversely, 
insanity  in  the  ancestors  of  neurasthenic  patients.  There  is  a 
bond  between  these  different  affections.  I  have  already  suffi- 
ciently indicated  this  in  denning  the  psychoneuroses.  I  know 
also  that  neurasthenia,  altho  slight  at  the  start,  may  be  merely 
the  forerunner  of  a  more  serious  affection,  and  develop,  in 
spite  of  all  our  efforts,  into  insanity.  But  I  am  still  more 
struck  by  the  favorable  aspect  which  this  disease  presents, 
even  in  the  forms  which  appear  severe  at  the  start.  Neuras- 
thenia is  at  the  bottom  of  the  psychopathic  ladder ;  it  is  in  the 
gray  of  the  blurred  photograph,  or  on  the  outer  border  of  the 
light  gray  in  which  we  all  are. 

One  finds  in  neurasthenic  people  the  whole  combination 
of  mental  stigmata,  but  the  chief  defect  seems  to  me  to  be  the 
tendency  to  tire,  to  become  easily  exhan  jd.  Even  the  word 
neurasthenia  indicates  it,  and  the  term  irritable  weakness,  which 
we  formerly  used,  characterizes  perfectly  the  habitual  condi- 
tion of  these  patients.  There  are  some  who  show,  in  all  the 
departments  of  their  activity,  the  insufficiency  of  their  capital 
of  energy.  Even  when  they  are  of  normal  weight,  enjoying 
normal  good  health,  when  they  are  young  and  well  developed, 
muscular,  and  free  from  anemia,  they  complain  chiefly  of  their 
weakness  and  their  asthenia.  They  can  not  endure  standing 
up,  or  sitting  long  in  any  position,  or  walking.  Sometimes 
they  take  themselves  in  hand,  and  start  off  to  walk,  or  to 
bicycle,  or  even  to  ride  horseback;  but  you  must  not  expect 
any  long-continued  effort  from  them;  they  are  exhausted 
immediately,  especially  if  the  task  is  imposed  upon  them  by 
some  one  else.  There  are  some  who  collapse  at  the  end  of  a 
few  minutes,  who  lie  down  upon  the  ground  and  can  not  even 
get  up  strength  enough  to  regain  their  bed;  there  are  others 
who  never  leave  their  bed. 

If,  as  often  happens,  this  condition  is  accompanied  by  dis- 
turbances of  the  visceral  functions,  by  gastrointestinal  dyspep- 
sia, by  palpitations,  and  by  insomnia,  one  has  the  impression 
of  being  in  the  presence  of  a  disease  that  is  entirely  somatic, 
of  an  amyosthenia  brought  on  possibly  by  malnutrition.  If  it 
concerns  a  woman,  the  gynecologist  lays  the  blame  to  a  retro- 


OF  NERVOUS   DISORDERS          161 

flexion  or  to  an  inflammation  of  the  uterus  which  he  claims  to 
have  found.  The  stomach  specialist  sees  nothing  but  dila- 
tation, ptosis,  enteritis,  and  muco-membranous  colitis.  The 
savant,  whose  glance  is  downward,  but  cast  from  the  summit  of 
a  tower  where  that  glance  can  not  sweep  the  whole  horizon, 
will  speak  of  gout,  rheumatism,  arthritis,  herpes,  or  of 
cholemia.  • 

But  the  asthenia  is  not  limited  to  this  apparently  physical 
muscular  weakness.  The  patient  is  intellectually  in  the  same 
condition  as  he  is  in  regard  to  muscular  exercise.  He  can  not 
read  for  any  length  of  time ;  he  can  not  fix  his  attention.  The 
slightest  effort  brings  on  headache,  neuralgia,  or  insomnia. 
This  fatigue  disturbs  the  digestion,  causes  palpitation,  gives 
rise  to  the  strangest  sensations,  and  renders  the  behavior  irri- 
table and  gloomy.  And  we  find  the  same  asthenia  in  the 
moral  domain.  The  insufficiency  of  potentiality  shows  itself 
in  the  functioning  of  the  entire  being;  the  powerlessness  is 
physical,  intellectual,  and  moral. 

And  always,  in  spite  of  the  distinctly  psychical  character  of 
many  of  the  disorders,  it  is  the  abdomen  that  gets  all  the  blame ; 
this  it  is  which  brews  all  these  humores  peccantes  (the  shade 
of  Sganarelle  just  passed  before  my  eyes),  which  changes  the 
cerebral  functioning.  And  then  we  have  complacently  de- 
scribed to  us  genital,  gastric,  hepatic,  arteriosclerotic,  gouty, 
and  arthritic  neurasthenias;  the  arterial  tension  is  measured, 
and  the  neuroses  are  classified  as  hypotonic  and  hypertonic. 
The  list  of  these  adjectives  will  become  interminable  if  we 
continue  to  take  exciting  agents  and  concomitant  affec- 
tions for  first  causes,  and  if  we  will  persist  in  seeing  in  the 
psychoneuroses  somatic  diseases,  in  the  narrower  sense  of  the 
word. 

The  whole  aspect  is  changed  and  becomes  clearer  as  soon 
as  one  recognizes  the  influence  of  congenital  predisposition  and 
of  natural  and  acquired  mentality. 

Undoubtedly  this  mental  debility  is  psychic  in  its  essence, 
for  what  we  call  mental  constitution  is  the  same  thing  as  cere- 
bral structure.  The  defect  may  perhaps  be  of  humoral  origin, 
for  the  condition  of  the  blood  can  influence  our  mentality. 


162  PSYCHIC   TREATMENT 

But  it  is  certain  that  as  yet  we  have  not  the  slightest  idea  of 
the  structural  or  chemical  changes  which  modify  our  thinking 
and  feeling  ego.  It  is  a  childish  conception  to  look  for  their 
origin  in  a  simple  functional  disturbance  of  our  splanchnic  or- 
gans and  to  attribute  everything  to  the  chemical  phenomena  of 
delayed  nutrition,  to  anemia,  plethora,  and  insufficiency  of  the 
hepatic  functions.  These  are  the  illusions  of  laboratory 
workers,  who,  having  discovered  a  little  chemical  truth,  take 
as  corner-stones  the  grains  of  sand  wrhich  they  have  brought 
to  the  building.  One  forgets  the  chasm  which  separates  even 
modern  physiology  from  the  clinic,  and  the  ever-precarious 
theory  from  practise. 

A  person  is  not  neurasthenic  in  the  same  way  that  he  is 
phthistical,  uremic,  cardiaopathic,  but  he  is  neurasthenic  just 
as  he  is  lazy,  undecided,  timid,  irritable,  and  susceptible.  Tell 
me,  please,  what  organic  chemistry  can  explain  these  peculi- 
arities of  our  psychic  being?  What  is  the  toxin  that  makes 
of  a  poetic  genius  a  Sadist  or  an  invert  ?  Do  we  bestow  energy 
upon  a  patient  who  has  lost  his  will-power  by  injecting  glycero- 
phosphates  into  him,  by  washing  his  blood  with  mineral  waters, 
by  making  his  cutaneous  vessels  contract  by  a  cold  douche,  or 
by  nourishing  him  exclusively  on  pap  ?  No !  It  is  a  question 
of  mental  conditions  and  of  psychic  peculiarities.  These  can 
be  fostered  and  aggravated,  I  know,  by  influences  which  are 
entirely  somatic;  for  we  have  here  an  instance  of  the  well- 
known  influence  of  the  physical  over  the  moral;  but  they  can 
be  equally  influenced  by  educative  efforts. 

I  have  said  that  by  virtue  of  psychophysical  parallelism 
this  influence,  however  moral  it  may  be  in  its  origin,  ought 
to  be  regarded  at  the  same  time  as  material,  but  it  deserves 
the  name  psychic,  because  the  cerebral  cure  is  brought  about, 
not  by  the  great  physicochemical  antidotes,  but  by  the  power- 
ful means  of  mental  representations.  The  therapeutic  impulse 
is  idiogenic  and  not  somatogenic. 

What  are  the  facts  which  lead  the  physician,  not,  indeed, 
to  deny  the  existence  of  physical,  intellectual,  and  moral  as- 
thenia, but  to  attribute  it  to  psychic  causes,  and  to  admit  the 
intervention  of  autosuggestions? 


OF  NERVOUS   DISORDERS          163 

The  first  is  the  very  exaggeration  of  this  asthenia.  The 
weakest  invalid  and  the  most  emaciated  convalescent  do  not 
reach  such  complete  states  of  exhaustion.  There  are  neuras- 
thenic persons  who  at  the  consultation  let  themselves  go  all 
to  pieces  and  flop  upon  the  sofa.  To  see  them  one  would 
believe  that  one  was  looking  at  a  patient  in  a  dead  faint  or 
exsanguinated.  However,  the  pulse  is  strong,  regular,  and  of 
normal  frequency ;  the  respiration  is  normal,  or  a  little  hurried, 
by  reason  of  anxiety ;  the  skin  is  normal  in  color,  the  muscles 
are  well  developed,  and  there  is  no  trace  of  paralysis.  The 
helplessness  of  the  man  is  in  striking  contrast  with  his  per- 
fection as  an  animal.  The  physician  recognizes  this  contrast 
in  a  moment,  on  the  briefest  examination,  and,  coordinating 
his  rapid  observations,  bases  upon  them  his  conclusions,  whose 
correctness  is  in  no  wise  compromised  by  the  rapidity  with 
which  he  reaches  them.  There  are,  unfortunately,  physicians 
who  do  not  possess  this  perceptive  glance  and  who  let  them- 
selves be  deceived  by  appearances.  I  have  had  patients  hur- 
riedly brought  to  me,  on  the  advice  of  some  physician,  by  the 
proprietor  of  a  hotel  who  feared  their  decease  in  his  establish- 
ment. I  have  let  them  rest  there  quietly,  with  the  absolute 
certainty  that  they  were  not  going  to  depart  this  life. 

The  exaggeration  which  appears  in  cerebral  fatigue  is  the 
same  as  that  in  the  fatigue  of  the  organs  of  sense.  One  finds 
it  in  the  asthenopia  of  neurasthenics,  in  their  incapacity  to  read 
or  to  fix  the  attention.  How  can  we  believe  in  the  reality  of 
an  asthenopia  in  a  patient  who  declares  himself  incapable  of 
reading  a  single  line  of  a  newspaper,  and  who,  when  it  is  a 
question  of  obtaining  something  that  he  wants,  sees  everything 
that  he  wishes  to  see,  both  near  and  far,  and  even  writes 
letters  ? 

And,  indeed,  we  recognize  also  in  the  moral  domain  this 
consciousness  of  helplessness,  and  the  trivial  ground  on  which 
the  patient  feels  discouraged  indicates  the  exaggerated  degree 
of  nervous  reaction.  What  can  we  say  of  these  neurotics 
who  sink  into  despair  when  their  milk  has  been  brought  five 
minutes  too  late,  who  throw  themselves  down  into  a  chair  in 
a  paroxysm  because  their  regular  physician  has  made  a  call 


164  PSYCHIC   TREATMENT 

without  being  announced?  This  emotion  is  enough  to  throw 
them  into  a  state  of  nervous  apoplexy!  Meet  these  patients 
with  a  kindly  smile,  but,  believe  me,  there  is  no  need  to  be 
alarmed  about  them! 

One  detects  also  in  the  majority  of  nervous  patients  sur- 
prising contradictions.  Thus,  when  they  have  just  told  you 
that  it  is  impossible  to  make  such  and  such  an  effort,  they 
show  that  they  are  quite,  if  not  more  than,  equal  to  it.  This 
was  the  case  of  a  physician  who,  believing  himself  com- 
pletely exhausted,  immediately  traced  for  me  an  ergographic 
curve  which  was  above  the  average. 

One  of  my  patients  showed  these  contradictions  most  com- 
pletely. Lack  of  motor  power  was  only  manifested  in  her  in 
the  muscular  group  to  which  she  directed  her  voluntary  at- 
tention, and  disappeared  immediately  when  the  movement  was 
performed  unconsciously.  Thus,  when  I  asked  her  to  sit  up 
in  bed,  she  only  allowed  herself  to  raise  her  head  a  few 
centimeters,  saying :  "  I  can  not."  She  made  no  effort  what- 
ever to  raise  her  body.  When  she  was  urged  to  try,  her  help- 
lessness increased,  her  face  became  sullen,  and  tears  gathered 
in  her  eyes.  Then  it  was  necessary  to  help  her  a  little  to 
raise  herself,  to  give  her  a  hand,  so  that  she  could  sit  up  in 
bed.  After  the  examination  was  over  she  laid  herself  down, 
without  letting  herself  fall  back,  by  leaning  slowly  backward 
by  degrees,  thus  making  a  muscular  effort  that  was  at  least 
equivalent  to  that  which  she  had  hitherto  been  besought  in 
vain  to  make. 

If  I  asked  her  to  bend  her  forearm  on  her  arm,  she  could 
not  do  it,  and  only  succeeded  in  bending  her  hand  on  her 
forearm.  But  when  I  told  her  to  raise  her  arm,  the  suggested 
helplessness  passed  into  the  crown  of  the  shoulder,  and,  with- 
out noticing  it,  the  patient  helped  this  movement  along  by  the 
flection  of  the  forearm  on  the  arm,  which  she  had  not  been 
able  to  execute  before.  All  movements  that  she  was  told  to 
make  seemed  impossible  so  long  as  her  attention  was  fixed 
on  the  muscular  masses  where  she  expected  the  contraction; 
they  became  easy  if  her  attention  was  drawn  to  another 
muscular  group. 


OF  NERVOUS   DISORDERS          165 

In  a  case  which  M.  Prof.  Dejerine  described  to  me,  one 
of  his  patients  was  not  able  to  use  her  arms  at  all  for  the 
slightest  work;  she  could  not  lift  the  smallest  object,  and  her 
arms  would  fall  as  if  paralyzed.  But  this  same  patient  per- 
formed without  any  difficulty  the  tiring  task  of  raising  her 
arms  to  do  her  hair.  Why?  Because  she  had  an  hyperesthe- 
sia  of  the  scalp  and  would  not  allow  her  hair  to  be  dressed  by 
her  maid!  This  fear  was  enough  to  dispel  the  amyesthesia. 

I  have  detected  another  contradiction  in  some  patients. 
They  used  to  say  that  they  were  incapable  of  bending  the 
foot  backward,  and  really  the  voluntary  effort  did  not  seem 
to  accomplish  anything.  I  then  electricized  the  anterior  tibia 
with  a  faradic  current,  causing  a  rhythmic  contraction  every 
two  seconds.  All  at  once  I  stopped  pressing  the  button,  and 
the  patient  continued  her  dorsal  flections  without  the  help  of 
the  current.  An  orthodox  electropath  would  interpret  this 
fact  as  proof  of  the  dynamogenic  action  of  induced  currents. 
Well,  no !  It  was  enough  for  me  to  call  the  patient's  attention 
to  this  phenomenon  and  show  her  that  she  had  been  caught  in 
the  very  act,  in  order  to  do  away,  once  for  all,  with  this  con- 
viction of  helplessness,  which  had  really  rendered  her  helpless. 

Such  of  your  patients  as  tell  you  that  they  can  not  stand 
the  fatigue  of  walking  will  dance  the  whole  night  without 
even  perceiving  the  disproportion  between  the  two  muscular 
efforts. 

The  same  contradiction  may  be  seen  in  the  intellectual  as- 
pect of  such  disorders.  One  of  my  patients,  an  intelligent 
young  woman,  told  me  that  she  was  not  able  to  give  her  chil- 
dren a  quarter  of  an  hour's  lesson.  She  wanted  to  devote  her- 
self to  this  task,  but  at  the  end  of  a  few  minutes,  she  said,  she 
would  be  taken  with  headache.  I  accepted  without  any  objec- 
tion the  fact  which  she  mentioned.  The  next  morning  when  I 
asked  her  what  she  did  when  she  spent  her  days  in  bed,  she 
replied  ingenuously :  "  Oh,  I  read  the  whole  day  long !  "  I 
smiled,  and  the  patient  instantly  colored,  for  she  saw  at  once 
the  contradiction  which  was  set  forth  in  these  two  successive 
assertions. 

I  have  seen  men  who  were  formerly  energetic  and  hard 


166  PSYCHIC   TREATMENT 

workers  fall  into  a  state  of  complete  intellectual  exhaustion. 
Their  lack  of  power  seemed  so  real  that  I  did  not  see  any 
other  solution  than  immediate  vacations.  But  it  was  impos- 
sible under  the  circumstances;  they  had  to  go  on.  Well,  I 
was  able,  in  these  cases,  in  an  hour  of  friendly  conversation, 
to  dispel  the  discouragement  and  debility,  more  moral  than 
physical,  which  caused  their  psychasthenia.  I  saw  these 
patients  take  up  the  work  which  seemed  impossible  to  them 
and  carry  it  on  successfully. 

I  have  observed  patients  who  could  not  read,  not  because 
they  were  unable  to  fix  their  attention  on  a  given  subject,  but 
because  the  letters  danced  before  their  eyes.  This  asthenopia 
disappeared  when  they  wrote,  not  only  when  they  scribbled  a 
letter,  but  when  they  undertook  a  work  of  arduous  composi- 
tion or  editing.  It  was  necessary,  however,  to  read  what  they 
wrote,  and  there  was  triple  fatigue  in  this  work:  cerebral, 
ocular,  and  muscular,  while  diverting  reading  of  one  kind  or 
another  would  seem  easy. 

I  do  not  say  that  all  neurasthenics  show  these  surprising 
contradictions.  There  are  a  great  many  in  whom  the  inca- 
pacity seems  more  regular,  of  whom  one  would  not  want  to 
say  that  it  might  be  more  real.  But  it  is  almost  always  pos- 
sible, by  an  attentive  analysis,  to  separate  the  nucleus  of  true 
fatigue  from  the  shell  of  autosuggestion.  The  physician  can, 
by  suggesting  different  movements,  while  turning  the  atten- 
tion of  the  patient  and  observing  him  unknown  to  himself, 
catch  him  in  the  act  of  unconscious  simulation,  if  I  might  so 
call  it. 

And  in  dyspeptic  troubles  how  many  contradictions  the 
patient  often  indicates  himself  by  saying :  "  One  day  I  can 
manage  a  hearty  meal,  the  next  day  I  suffer  in  spite  of  the 
care  which  I  have  taken  to  eat  nothing  but  light  food." 

It  is  not  rare  to  see  headaches  disappear  by  reason  of  a 
distraction,  or  a  pleasant  visit,  even  when  the  patient  feared, 
more  than  anything  else,  the  fatigue  of  conversation. 

The  psychic  nature  of  various  kinds  of  loss  of  power  is 
often  disclosed  by  the  strangeness  of  the  causes  which  give 
rise  to  them  or  aggravate  them. 


OF  NERVOUS   DISORDERS          167 

One  of  my  patients,  who  for  twelve  years  could  not  remain 
standing  for  any  length  of  time,  could  still  pass  from  one 
room  to  another,  but  his  limbs  would  slip  away  from  under 
him  if  the  handle  of  the  door  did  not  yield  easily  to  his 
pressure.  There  was  no  material  connection  between  this 
difficulty  of  opening  a  door  and  the  act  of  standing.  But  the 
patient  found  an  obstacle  in  his  way  which  would  prolong  the 
time  that  he  had  to  stand,  and,  as  he  had  a  phobia  for  this 
position,  his  limbs  refused  to  support  him. 

Another,  attacked  by  a  melancholic  type  of  neurasthenia, 
called  my  attention  particularly  to  his  sensitiveness  to  light, 
and  said  to  me :  "  When  I  am  at  the  window,  and  a  ray  of 
sunshine  lights  up  my  book,  I  feel  well  and  happy  and  lively ; 
but  if  a  cloud  passes  over  the  sun  I  fall  back  into  my  state  of 
anxiety." 

And  this  patient  insisted  that  it  was  the  suppression  of 
the  sun's  rays  which  acted  physiologically  upon  him.  "  Not 
at  all,"  said  I  to  him,  "  these  reactions  are  established  by 
means  of  the  mind.  There  are  in  our  understanding  some 
ready-made  associations  of  ideas,  such  as  sunshine-happiness, 
shadow-sadness.  It  is  this  group  of  previously  coupled  ideas 
which  comes  into  the  mental  mechanism.  This  is  so  true  that 
you  will  find  that  you  can  read  with  perfect  mental  equanimity 
when  you  comfortably  sit  yourself  down  in  the  shadow  of  a 
wall  where  you  are  sheltered  from  the  sun's  rays.  It  is  only 
the  idea  of  the  cloud  which  casts  its  shadow  over  your  soul." 

A  patient,  who  showed  himself  rather  skeptical  on  the 
subject  of  my  theories  concerning  the  intervention  of  ideas  in 
our  sensations,  said  to  me  one  day :  "  I  will  point  out  to  you 
to-morrow  a  phenomenon  which  occurred  in  my  personal  ex- 
perience, and  I  shall  be  very  much  surprised  if  you  can  discover 
any  psychic  influence  in  it."  The  next  day  he  narrated  to  me 
what  follows: 

"  I  was  obliged,  several  years  ago,  to  do  some  gardening, 
and,  in  particular,  to  carry  some  potted  geraniums  over  to 
another  flower  border.  Following  this  work,  I  was  taken  with 
an  agonizing  cramp  in  the  region  of  my  stomach.  I  soon  dis- 
covered the  reason  of  this  strange  sensation.  It  was  the  red 


168  PSYCHIC  TREATMENT 

of  the  geraniums  which  brought  it  on,  and  I  have,  since  then, 
had  certain  proof  of  it.  Bright  red  always  produces  this 
effect  upon  me,  and  the  reaction  is  just  in  proportion  to  the 
intensity  of  the  red ;  so  that  if  I  take  up  a  book  with  red  edges 
the  sensation  is  at  its  maximum  when  the  book  is  closed,  and 
it  decreases  if  I  lessen  the  color  intensity  by  turning  the  leaves 
over!" 

"  My  dear  sir,"  I  replied  to  him,  "  you  could  not  furnish 
me  with  a  more  typical  example  of  pure  autosuggestion,  based 
upon  a  hasty  conclusion.  I  accept  the  fact  that  you  have  ex- 
perienced this  cramp  in  your  stomach.  Why,  I  do  not  know. 
I  can  not  go  into  all  that  happened  on  that  day.  Perhaps  it 
was  physical  fatigue  that  upset  you,  or  the  attitude  of  bending 
the  body.  Perhaps  you  had  eaten  something  that  disagreed 
with  you.  How  do  I  know  ?  In  any  case,  it  was  not  the  red 
which  could  in  itself  have  made  such  an  impression  upon  your 
organs  and  caused  this  sensation.  The  fact  that,  since  then, 
red  has  always  acted  in  the  same  way,  does  not  prove  anything. 
You  are  under  the  effect  of  an  autosuggestion,  and,  as  a  mental 
suggestion  creates  a  sensation  just  as  long  as  it  is  not  dissipated 
by  a  contrary  autosuggestion,  you  have  persisted  in  what  we 
would  call  your  erythrophobia."  "  But,"  he  objected,  "  the  red 
rays,  nevertheless,  have  much  slower  vibrations  than  the  violet 
rays."  "  You  are  right ;  but  you  do  not  use  your  ideas  of 
physics  in  the  right  place.  The  length  of  the  wave  of  the  red 
vibrations  explains  their  feeble  action  on  the  photographic 
plate,  but  does  not  tell  us  anything  of  the  action  which  these 
rays  ought  to  have  on  our  stomach  or  on  our  nervous  sys- 
tem. You  are  caught  in  the  net  of  your  autosuggestions, 
a  net  which  you  have  constructed  yourself  by  the  associations 
of  irrational  ideas." 

He  looked  at  me  with  a  very  skeptical  air,  but  next  day 
he  spread  out  upon  his  bed  a  large  red  cloth,  and  assured  me 
that  the  effect  on  his  stomach  had  disappeared.  One  day, 
however,  I  found  the  patient  in  despair;  he  had  thrown  the 
hateful  cloth  away.  He  had  another  attack,  but  he  announced 
to  me  himself  that  he  was  going  to  master  his  phobia,  and  he 
succeeded  in  fully  doing  so. 


OF  NERVOUS    DISORDERS          169 

The  same  defective  logic  may  be  discerned  in  a  host  of 
abnormal  sensibilities,  and  it  is  more  useful  for  the  physician 
to  thoroughly  get  hold  of  purely  mental  phenomena  than  to 
study  the  gastric  chemistry  of  a  menu,  to  measure  the  patient's 
strength  by  a  dynamometer,  or  to  analyze  his  urine  from  the 
standpoint  of  various  coefficients  of  excretion. 

Neurasthenia  affects  chiefly  the  moral  element  in  us,  and 
appears  most  distinctly  as  psychasthenia,  or  mental  depression 
and  debility. 

The  neurasthenic  patient  is  easily  discouraged ;  he  has  no 
confidence  in  himself.  His  mental  state  is  unstable ;  it  under- 
goes continual  variations,  sometimes  under  the  influence  of 
secret  causes,  which  it  is  impossible  to  analyze,  sometimes 
under  the  influence  of  fatigue,  or  of  various  real  or  imaginary 
emotions. 

What  strikes  us  most  of  all  is  the  inadequacy  of  the  mo- 
tives. Tragic  events  and  great  catastrophes  do  not,  as  a  rule, 
determine  the  acute  crises.  Often  nervous  patients  show  a 
remarkable  indifference  under  such  circumstances,  perhaps, 
because  they  have  their  interest  too  closely  fixed  upon  them- 
selves. It  is  the  little  pin-pricks  that  they  can  not  bear — these 
numerous  trifling  vexations  and  the  daily  annoyances  with 
which  life  is  bestrewn. 

Some  are  undecided  and  incapable  of  responsibility,  and 
the  necessity  of  taking  part  in  some  unimportant  question 
plunges  them  into  a  state  of  melancholy  anxiety.  Often  trivial 
events  bring  on  an  attack  of  depression,  and  immediately  a  tinge 
of  sadness  extends  involuntarily,  not  only  over  the  actual  affair, 
but  over  the  whole  aspect  of  life.  A  failure  in  some  little  piece 
of  work  is  sufficient  to  bring  about  this  sudden  change  of  men- 
tal disposition,  and,  a  propos  of  nothing  at  all,  the  patient  asks 
himself  whether  life  is  worth  the  trouble  of  living. 

The  so-called  normal  man  may  experience  similar  sensa- 
tions. We  all,  when  we  are  tired,  allow  at  times  the  dark 
curtain  of  discouragement  to  unfurl  itself  too  far.  But  we 
regain  control  of  ourselves,  and  soon  recover  our  smiles,  some- 
times a  little  ashamed  of  the  ease  with  which  we  have  allowed 
ourselves  to  be  cast  down.  Sometimes  we  let  ourselves  be 


170  PSYCHIC   TREATMENT 

suddenly  cheered  up  by  a  trifling  autosuggestion,  which  is  at 
least  beneficent,  as  do  smokers,  for  whom  a  cigar  is  the 
means  of  diminishing  half  their  troubles  and  doubling  their 
pleasures.  There  is  something  of  a  psychasthenic  element  in 
this  ease  with  which  a  man  lets  himself  be  comforted  by  a 
trifle.  The  neurasthenic  person  is  still  more  variable  in  this 
matter  of  the  moral  attitude  toward  life,  and  it  is  toward  the 
pessimistic  side  that  he  always  leans.  With  him  the  dark 
curtain  hangs  very  low,  and  he  does  not  know  how  to  raise 
it  by  a  consoling  reflection. 

Certain  neurasthenic  persons  are  susceptible  to  the  last 
degree ;  there  is  in  some  of  them  an  element  of  "  moral  in- 
sanity," and  the  most  kindly  rebuke  is  a  discouragement  and 
disperses  the  good  resolutions  which  they  seemed  to  make. 
Often  they  harshly  accuse  their  relatives,  a  wife,  or  a  friend, 
of  having  destroyed  their  enthusiasm;  they  put  a  wrong  in- 
terpretation upon  the  advice  of  their  superiors;  they  read 
reproaches  between  the  lines  of  a  friendly  letter;  they  believe 
themselves  misunderstood  and  persecuted. 

The  world  is  full  of  these  unstable,  sensitive,  and  emotional 
neurasthenics,  who  are  thrown  off  their  balance  by  the  slight- 
est annoyance.  Their  weak  reason  has  not  the  strength  to 
oppose  these  real  or  imaginary  troubles  with  a  mild  stoicism. 
Many  find  their  only  comfort  in  alcoholic  drinks,  morphine, 
cocaine,  and  chloral. 

The  nervous  patients  who  intoxicate  themselves  are  by  no 
means  people  confirmed  in  bad  habits;  they  are  psychopaths, 
who  physically  and  morally  are  subject  to  unpleasant  feelings, 
and  can  not  recover  the  sense  of  well-being,  excepting  under 
the  influence  of  an  intoxicant. 

Suicide  may  even  be  the  terminal  event  in  the  life  of  cer- 
tain neurasthenics  in  whom  weariness  of  life  has  been  a  domi- 
nating influence.  This  is  not  the  act  of  a  melancholic  who  is 
affected  by  a  more  or  less  sudden  impulse;  it  is  suicide  by 
reason  of  discouragement,  under  the  influence  of  a  momentary 
moral  suffering;  suicide,  where  the  patient  quickly  is  brought 
to  repentence  if  his  attempt  proves  abortive. 

It  often  occurs  from  the  most  trivial  causes.     This  school- 


OF  NERVOUS   DISORDERS          171 

boy  hangs  himself  because  he  has  failed  in  an  examination 
or  because  he  fears  a  paternal  scolding.  Another,  a  physician, 
kills  himself  by  a  dozen  stabs  of  his  penknife  in  his  heart  be- 
cause he  can  not  bear  an  absurd  slander  which  has  been  spread 
abroad  concerning  him,  even  when,  after  the  lawsuit,  his  honor 
has  been  vindicated,  and  he  has  been  upheld  by  the  esteem  of 
his  relatives  and  friends. 

In  short,  the  most  characteristic  thing  about  the  neuras- 
thenic is  his  mentality.  The  functional  disorders  which  he 
experiences  have  nothing  very  special  about  them,  and  are 
often  found  in  normal  people.  But,  by  virtue  of  his  hypo- 
chondriacal  mentality,  the  neurasthenic  magnifies  things  and 
alarms  himself.  He  is  autosuggestible,  sensitive,  and  emo- 
tional ;  but  the  dominant  thing  about  him  is  his  fatigability. 
It  is  in  a  large  part  autosuggested,  dependent  on  a  pessimistic 
state  of  mind,  but  it  is  also  real,  and  always  still  more  aggra- 
vated by  the  emotional  fatigue  which  results  from  thinking 
about  it.  It  is  to  this  fatigue  that  I  attribute,  without  excluding 
the  always  possible  intervention  of  autosuggestions,  certain 
unpleasant  phenomena,  such  as  those  frequent  headaches  and 
spinal  pains  of  neurasthenics  which  they  call  pain  in  the  back 
and  head.  These  phenomena  may  also  be  amenable  to  purely 
moral  measures.  I  have  seen  a  great  many  examples  of  them ; 
but  they  yield  more  quickly  when  the  element  of  fatigue  is 
taken  into  account,  and  when  psychotherapic  treatment  is  com- 
bined with  overfeeding,  massage,  and  all  the  proper  physical 
means  for  strengthening  the  body. 

But  while  recognizing  in  neurasthenia  the  bodily  symptoms 
which  are  in  a  certain  degree  amenable  to  hygienic  treatment, 
I  hold  to  the  psychasthenic  character  of  this  affection. 

Whoever  wishes  to  treat  neuropaths  must  first  of  all  be 
a  good  clinician,  in  order  to  recognize  the  numerous  organic 
troubles  and  to  assign  them  their  place;  but  he  must  also  be 
a  psychologist  and  moralist,  in  order  to  completely  modify  the 
mentality  of  his  patient. 


172  PSYCHIC  TREATMENT 


CHAPTER   XIV 

Hysteria:  Its  Characteristic  Stigma  is  Autosuggestibility — Passional  Atti- 
tudes— Natural  Predisposition — Feminine  Mentality — Mental  Infantil- 
ism — Hysteroneurasthenia — Traumatic  Forms — Anesthesias — Hyster- 
ical Fevers 

THE  complaints  of  the  neurasthenic  do  not  astonish  us. 
We  have  all  experienced  these  feelings  of  weakness,  and  we 
might  say  that  everybody  is  more  or  less  neurasthenic.  The 
same  thing  has  sometimes  been  said  of  hysteria  in  the  state- 
ment that  all  women,  and  a  large  percentage  of  the  men,  are 
hysterical. 

But  that  is  going  much  too  far.  Undoubtedly  one  finds 
in  hysteria  the  same  mental  peculiarities  as  in  the  other  neu- 
roses. The  hysterical  subjects  are  nearly  all  eminently  fatig- 
able,  sensitive,  and  emotional;  we  might  say  that  they  are  all 
neurasthenic,  but  the  symptomology  of  hysteria  is  strange  and 
peculiar.  We  recognize  at  first  in  these  patients  something 
more  than  normal  reactions  simply  exaggerated.  There  is 
something  demoniacal  in  the  clinical  picture  of  this  psycho- 
neurosis.  The  organic  functioning  seems  sometimes  so 
astray  that  hysteria  has  been  called  the  body's  madness.  The 
expression  is  not  correct,  for  there  is  no  insanity  of  the  body, 
but  it  describes  with  a  certain  picturesqueness  the  peculiarity 
of  the  symptoms. 

In  neurasthenia  I  have  pointed  out  as  the  principal  stig- 
ma, fatigability,  insisting  upon  the  role  that  the  mind  plays 
in  such  fatigue.  In  the  hysterical  patient  suggestibility  is  the 
dominant  quality,  or,  more  exactly,  auto  suggestibility. 

The  normal  man  is  eminently  suggestible,  and  when  one 
realizes  the  effects  of  suggestion  in  the  waking  state,  and  re- 
flects on  the  enormity  of  the  suggestions  which  one  can  make 


OF   NERVOUS    DISORDERS          173 

healthy  men  accept,  one  wonders  how  one  can  still  speak  of 
the  exaggerated  suggestibility  of  the  neuroses. 

But  in  general  the  normal  man  does  not  show  this  cre- 
dulity unless  he  is  in  those  psychological  conditions  which 
render  the  suggestions  that  are  made  to  him  more  or  less 
plausible.  The  weak-minded  neurasthenic  allows  himself  to 
be  impressed  by  the  numerous  functional  troubles,  which  he 
feels,  as  we  all  do,  but  which  he  magnifies  on  account  of  the 
hypochondriacal  state  that  he  is  in.  He  also  accepts  easily 
favorable  suggestions  and  encouragement.  The  hysterical  per- 
son is  more  rebellious  to  heterosuggestion,  while  her  autosug- 
gestions are  tenacious  and  bizarre.  She — I  say  "  she  "  because 
the  woman  is  more  subject  to  these  symptoms — lives  in  a  world 
of  dreams,  and  in  the  graver  cases  that  come  within  the  prov- 
ince of  the  alienist  the  mental  trouble  amounts  to  hysterical 
delirium. 

These  patients  are  experts  in  the  art  of  putting  the  stamp 
of  reality,  not  only  on  their  sensations,  as  in  the  neurasthenic, 
but  on  the  phantoms  created  by  their  most  vagrant  imagina- 
tion. While  in  the  neurasthenics  one  can  follow  quite  easily 
the  genesis  of  the  idea  and  the  development  of  the  phobias 
and  establish  a  certain  logic  in  the  deductions,  it  is  often  im- 
possible to  trace  the  main  thread  in  the  phantasmagoria  of 
hysterics.  It  seems  as  tho  the  autosuggestions  were  provoked 
by  strange  sensations,  arising  out  of  the  depths  of  the  organ- 
ism, by  a  special  pathological  ccenesthesis. 

Even  in  the  normal  woman  there  is  some  derangement  in 
the  psychic  life ;  during  the  menstrual  period  there  are  special 
sensibilities  which  are  foreign  to  the  mentality  of  the  male, 
and  which  we  have  never  been  able  to  comprehend.  I  am  led 
to  believe  that  the  various  vague,  conscious  or  unconscious, 
sensations  which  pertain  to  the  sexual  instinct  play  even  in 
the  virgin  of  the  most  immaculate  thoughts  a  considerable 
role  in  the  genesis  of  hysteria.  But  they  produce  unhealthy 
autosuggestions  only  in  the  subjects  that  are  so  predisposed 
and  in  those  of  weak  mentality. 

Among  the  dramatic  symptoms  of  hysteria  one  must  in- 
clude, first  of  all,  the  various  kinds  of  attacks — epileptiform, 


174  PSYCHIC  TREATMENT 

cataleptiform,  lethargic,  and  choreiform,  as  well  as  palsies. 
These  movements  partake  of  the  nature  of  passional  attitudes ; 
we  are  witnesses  at  scenes  of  mimic  insanity  which  indicate 
the  subject's  mental  state.  It  is  often  enough  to  observe  the 
details  of  the  convulsive  movements  and  gestures  to  be  able 
to  guess  the  sentiments  which  have  given  birth  to  them,  such 
as  anger,  fear,  spite,  and  impatience. 

Rythmic  movements  of  the  pelvis  betray  a  lascivious  state 
of  mind,  whether  it  is  conscious  or  unconscious,  in  the  most 
modest  young  girl  as  well  as  in  the  prostitute.  Certain  hys- 
terical cries  are  only  the  culmination  of  rage  or  exaggerated 
demonstrations  of  spite.  One  recognizes  fright  in  the  atti- 
tudes of  patients  who  have  undergone  violent  emotion,  often 
at  the  time  of  their  menses.  You  will  see  them  assume  a  sit- 
ting posture,  cowering  down  in  their  bed  as  far  as  possible 
from  the  people  present,  fixing  haggard  eyes  on  the  corner  of 
the  room,  as  if  the  prey  of  terrifying  hallucinations. 

It  is  not  rare  to  find  among  young  girls  and  young  men 
semicomatose  states,  in  which  the  patients  remain  stretched 
out  on  the  bed,  or  sofa,  or  on  the  ground,  perfectly  inert,  with 
jaws  clinched  and  eyes  convulsively  closed.  They  have  been 
irritated,  or  contradicted,  and  they  are  sulking. 

It  is  in  hysteria  that  one  sees  infinitesimal  traumatisms, 
which  would  have  no  consequences  for  the  healthy  man,  or 
even  for  a  neurasthenic,  lead  up  to  paralysis,  contractures,  or 
various  painful  states  which  will  last  for  years. 

A  young  girl,  for  example,  slips  in  the  street  and  sits  down 
violently  on  the  ground.  There  is  no  lesion,  no  ecchymosis, 
no  hematoma,  but  there  results  an  hysterical  coxalgia  that  is 
somewhat  difficult  to  distinguish  from  true  hip-disease.  A 
boy  twists  his  foot.  There  is  no  rupture  of  the  ligaments  and 
no  swelling,  yet  in  spite  of  the  absence  of  lesions  the  foot  re- 
mains painful  for  some  weeks,  the  skin  becomes  sensitive  to 
the  slightest  touch — so  much  so,  that  the  patient  can  not  bear 
even  the  pressure  of  the  sheet  or  the  touch  of  the  hand. 

The  autosuggestive  nature  of  the  majority  of  symptoms 
is  very  well  shown  by  the  frequency  of  hysterical  contagion. 
We  have  only  to  recall  the  epidemics  of  rhythmic  chorea  in 


OF  NERVOUS   DISORDERS          175 

the  middle  ages.  They  have  not  wholly  ceased,  and  not 
long  ago  we  were  able  to  observe,  at  Bale  and  at  Berne,  epi- 
demics of  hysterical  chorea  in  boarding-schools  of  young  girls. 
At  Berne  thirty  little  girls  were  taken  with  articular  pains 
and  rhythmic  movements  of  the  arms.  It  was  necessary  to 
separate  the  patients  in  order  to  stop  these  attacks,  which 
were  purely  imitative. 

These  facts  offer  food  for  reflection.  It  has  often  been 
said,  and  with  reason,  that  there  must  be  a  neuropathic  pre- 
disposition and  provoking  agents  to  bring  on  an  attack  of 
hysteria.  But  it  is  hardly  possible  that  these  thirty  little  girls, 
born  of  different  parents,  had  all  a  special  predisposition,  and 
were  all  budding  hysterics.  I  am,  on  the  contrary,  persuaded 
that  the  majority  of  them  will  have  no  further  symptoms.  It 
must  have  been  the  same  with  the  women  who  took  part  in 
the  saltatory  or  dancing  epidemics  in  the  middle  ages. 

These  young  girls  found  themselves  in  certain  conditions 
of  companionship  and  intimacy  which  created  a  psychological 
condition  favorable  to  contagion,  and  they  succumbed  to  it 
by  reason  of  a  weakness  of  judgment  which  is  very  natural 
at  that  age.  Suggestibility  has  no  limits  in  the  normal  child 
because  of  the  insufficient  development  of  the  reason. 

Adults  who  preserve  this  incredible  suggestibility  and  be- 
come hysterical  manifest  thereby  their  mental  debility.  The 
hysterical  woman  has  an  infantile  mentality,  she  suffers  from 
psychic  infantilism.  The  hysterical  man,  who  does  not,  as 
a  rule,  show  such  skill  in  the  creations  of  his  imagination,  has 
a  more  or  less  distinctly  feminine  mentality. 

The  hysterical  person  is  not,  as  a  rule,  truly  intelligent. 
Oh,  I  know  that  there  has  been  much  protest  against  this 
assertion,  and  that  cases  of  hysteria  have  been  quoted  in 
persons  of  remarkable  intelligence.  I  agree  to  that ;  but  such 
patients  have  only  partial  intelligence ;  they  have  not  the  robust 
good  sense  which  one  often  finds  in  uncultured  persons,  whose 
ignorance  we  often  wrongly  take  for  stupidity.  I  myself  have 
found  some  rare  exceptions  to  the  rule:  I  have  detected  hys- 
teria, in  severe  convulsive  or  delirious  forms,  in  intelligent 
persons  of  a  high  degree  of  moral  culture;  but  they  had, 


176  PSYCHIC   TREATMENT 

nevertheless,  some  mental  obliquity,  such  as  a  wandering  im- 
agination, and  a  tendency  to  let  the  fool  in  their  upper  story 
govern  them.  A  little  balance,  and  they  would  have  been 
poets.  It  is  after  the  suppression  of  these  accidents  that  I 
have  noted  their  culture,  but  it  was  still  to  their  reason  that 
they  owed  their  cure. 

A  true  savant,  or  intellectual  man,  might  be  neurasthenic ; 
he  would  never  be  an  out-and-out  hysteric ;  and  it  is  precisely 
by  making  an  appeal  to  his  judgment,  and  to  his  logical 
faculties,  that  one  can  succeed  in  drawing  him  out  of  his 
neurasthenic  condition. 

The  mental  defect  is  decidedly  more  marked  in  the  hys- 
teric; the  intellectual  and  moral  debility  is  more  profound 
than  in  the  neurasthenic.  Prostitutes,  those  unfortunates 
unbalanced  by  heredity  and  education,  are  often  hysterical, 
and  society,  probably  as  a  therapeutic  measure,  brands  them 
with  the  hot  iron  of  official  regulation. 

Boys,  as  long  as  they  have  the  infantile  mentality,  can  be 
just  as  hysterical  as  girls.  I  have  often  seen  boys  afflicted 
with  hysterical  paraplegia,  aphonia,  mutism,  convulsive  and 
delirious  crises,  in  which  the  patient  screams  out,  volubly 
pouring  forth  senseless  words,  often  in  an  unknown  language. 

As  soon  as  puberty  has  brought  about  a  change  in  the 
mental  state,  and  reason  has  begun  to  develop,  hysteria  di- 
minishes in  the  male.  The  difference  between  the  masculine 
mentality  and  the  feminine  is  accentuated.  The  young  man 
becomes  less  sensitive;  he  thinks  more  logically.  The  young 
girl,  on  the  other  hand,  altho  she  may,  as  a  rule,  be  more  de- 
veloped intellectually  than  the  boy  of  the  same  age,  remains 
sensitive ;  she  obeys  more  readily  the  promptings  of  the  senses 
than  the  motives  of  reason.  The  adult  man  has,  as  a  rule,  a 
more  logical  head  than  the  woman.  Moreover,  he  does  not 
so  easily  become  hysterical  under  the  influence  of  the  numerous 
little  causes  which  are  sufficient  to  make  a  woman  hysterical. 

But  this  mental  disequilibrium  occurs  as  a  consequence  of 
violent  emotions  and  moral  shocks.  Various  traumatisms — 
above  all,  railroad  accidents — often  bring  on  such  psychoneu- 
roses,  which  have  been  called  traumatic  neuroses.  (One  must 


OF   NERVOUS    DISORDERS          177 

not  use  this  word  in  the  singular,  for  it  is  not  a  morbid  entity 
that  is  described  under  this  word.) 

According  to  the  predispositions  of  the  subject,  these  may 
arise  from  the  simple  fact  of  a  psychic  shock,  not  only  neur- 
asthenia and  hysteria,  or  a  combination  of  these  two  closely 
related  neuroses,  but  also  hypochondria,  melancholia,  and  va- 
rious insanities.  One  might  add  the  epithet  traumatic  to  all 
these  psychoses,  or  psychoneuroses,  and  thus  indicate  the 
fact  that  the  accident  has  played  the  role  of  exciting  cause. 

Hystero-neurasthenia  is  the  most  frequent  form  of  the  dis- 
order which  results  from  these  violent  shocks.  This  psycho- 
neurosis  is  particularly  obstinate  in  the  cases  which  originate 
in  the  mental  anxieties  incident  to  suretyships  and  lawsuits,  by 
which  the  patient  is  kept  in  a  restless  condition.  It  is  often 
incurable  and,  as  in  certain  forms  of  nontraumatic  hysteria, 
we  are  led  to  ask  whether  there  may  not  be  cerebral  or 
medullary  lesions. 

It  might  be  possible  that  the  traumatism  had  directly  pro- 
duced mental  deteriorations  of  this  kind ;  it  is  also  possible 
that  the  lasting  neurosis  creates  little  by  little,  by  the  repe- 
tition of  functional  disorders,  certain  changes  of  the  tissue. 
Do  not  let  us  forget  that  in  the  slightest  psychoneurosis  we 
must  admit  an  anatomical  substratum,  a  structural  change. 
What  wonder,  then,  that,  in  the  more  serious  forms,  it  becomes 
more  profound  and  more  lasting?  There  is  an  ultimate  limit 
where  the  simple  functional  diseases  pass  into  organic  affec- 
tions. On  the  other  hand,  we  see  incurable  diseases,  such  as 
Parkinson's  disease,  and  very  serious  maladies,  such  as  Base- 
dow's  disease,  occurring  under  the  influence  of  an  emotion 
which,  at  the  beginning,  could  only  alter  the  function. 

The  anesthesias  which,  as  a  rule,  are  considered  as  char- 
acteristic stigmata  of  hysteria,  are  difficult  of  interpretation. 
Such  anesthesia  sometimes  resembles,  in  its  localization  and 
distribution,  the  loss  of  sensibility  which  results  from  cerebral, 
medullary,  or  peripheral  lesions.  Hysterical  hemianesthesia 
recalls  the  symptomatic  hemianesthesia  of  lesions,  which 
are  situated  in  the  posterior  third  of  the  internal  capsule. 
Sometimes  it  has  even  seemed,  from  the  nature  of  the  distribu- 


178 

tion  of  the  anesthesia,  as  tho  it  were  due  to  a  root  lesion,  or 
to  a  lesion  of  the  peripheral  nerve  trunks. 

This  question  demands  a  more  thorough  examination.  It 
would  be  of  great  importance  in  the  interpretation  of  hysteria 
to  know  if  it  were  really  possible,  without  the  patient's  knowl- 
edge of  anatomical  facts,  or  any  preliminary  suggestion,  this 
anesthesia  can  truly  simulate  that  of  organic  lesions. 

But,  whatever  may  be  its  localization,  whether  it  be  com- 
plete and  spread  out  over  the  entire  skin,  or  whether  it  be 
unilateral,  or  in  bands,  or  patches,  this  anesthesia  is  peculiar. 
Altho  anesthetic  in  her  entire  body,  the  hysterical  person  can 
move  about  like  a  normal  person,  can  do  delicate  needle  work, 
which  would  be  impossible  if  there  were  the  slightest  anes- 
thesia of  the  fingers,  due  to  carbolic  acid,  to  pressure,  or  to 
cold.  Patients  affected  with  anesthesia  from  a  lesion  of  a 
nerve  trunk,  as  in  a  disease  such  as  syringomyelia,  can  burn 
themselves  without  perceiving  the  contact  with  a  hot  body; 
the  hysterical  person  takes  good  care  not  to  do  that.  If  sur- 
prised by  a  prick  in  the  anesthetic  region,  the  hysteric  some- 
times trembles  in  such  a  way  as  to  make  one  doubt  the  reality 
of  her  insensibility. 

There  is  the  same  contradiction  in  the  sensorial  anesthe- 
sias, such  as  in  amaurosis,  or  hysterical  blindness.  For  ex- 
ample: a  certain  patient  who  can  not  see  one  person  can  see 
his  neighbor  very  well;  one  can,  by  a  suggestion,  make  such 
and  such  a  person,  such  and  such  an  object,  disappear  before 
his  eyes,  or,  rather,  from  his  understanding.  One  can,  by  sug- 
gestion, make  the  impression  fall  on  a  sort  of  blind  spot,  the 
" punctum  ccecum"  (of  Mariotte)  of  the  understanding. 

When  I  speak  here  of  the  "  blind  spot,"  I  do  not  mean  by 
that  that  there  is,  in  the  brain,  a  group  of  inactive  cells  con- 
gealed into  a  sickly  torpor.  I  mean  that  it  is  the  attention 
which  is  diverted,  and  I  would  accept  the  idea  of  Janet,  who 
sees  in  hysterical  anesthesia  a  sort  of  sensorial  distraction. 

I  still  believe  in  the  purely  autosuggestive  nature  of  all 
these  'hysterical  anesthesias.  By  verbal  suggestion  one  can 
make  them  increase  and  diminish,  or  enlarge  the  field  of  visual 
perception.  It  seems  as  tho  seeking  for  anesthesia  created  it, 


OF  NERVOUS   DISORDERS          179 

for  the  hysterical  person  has  no  knowledge  of  any  trouble 
with  his  sensibilities. 

Thus  Pierre  cle  Lancre,  that  parliamentary  counsellor  of 
Bordeaux  who  himself  lit  the  fagots  around  more  than  five 
hundred  hysterical  sorcerers,  made  the  remark  that  the  "  sig- 
num  diaboli,"  on  which  he  founded  the  proof  of  guilt,  was 
not  noted  by  the  subject.  The  sorcerers  were  completely  ig- 
norant of  the  fact  that  they  had  been  marked  until  they  had 
been  examined.1 

We  also  find  that  our  hysterics  only  have  hemianesthesia 
when  we  examine  them,  and  when  we  ask  them  if  they  expe- 
rience the  same  sensation  on  both  sides.  More  often  we  can 
work  a  transfer,  not  only  by  magnets  and  metallotherapy,  but 
by  some  kind  of  a  suggestion. 

Undoubtedly,  it  is  striking  to  see  so  many  hysterics  avow, 
at  the  start,  without  any  hesitation,  that  they  feel  less  on  the 
left  side,  when  other  patients  whom  we  examine  in  the  same 
way  do  not  experience  any  difference.  One  could  really  be- 
lieve that  there  is  a  true  torpor  there,  and  not  a  suggested  one 
in  certain  centers  of  perception.  But  let  us  take  care!  The 
autosuggestions  are  not  born  slowly  nor  based  on  conscious 
syllogisms;  they  occur  instantaneously,  by  mental  representa- 
tions, whose  development  one  can  not  always  follow.  The 
hysteric,  rebellious  to  reasonable  therapeutic  heterosuggestions, 
is  often  incredibly  sensitive  to  pathogenic  suggestions.  Her 
irrational  mentality  makes  her  prefer  them,  if  I  may  dare  so 
to  speak. 

Even  before  I  had  reflected  on  these  problems,  at  the  be- 
ginning of  my  career.  I  had  the  impression  that  it  was  not 
necessary  to  look  for  the  symptoms  of  hysterics.  To  mention 
them  was  to  bring  them  into  existence.  Thus  it  has  been  my 
habit  to  make,  during  the  first  few  days  in  which  I  am  inter- 
ested in  a  case,  certain  useful  tests,  to  jot  down  their  results, 
and  then  I  give  up  further  examinations.  During  the  rest  of 
the  treatment  I  do  not  look  at  the  paralyzed  legs,  I  do  not 
ask  whether  there  is  sensation  to  the  prick  of  the  needle;  I 


1  Gilles  de  la  Tourette.     TraM  clinique  ei  iherapeutique  de  r hysteric.    Paris,  Plon, 

1891. 


180  PSYCHIC   TREATMENT 

take  it  for  granted  that  these  disorders  no  longer  exist.  And 
at  the  end  of  the  treatment  there  is  no  longer  either  paralysis 
nor  hemianesthesia — at  least,  in  the  great  majority  of  these 
cases. 

In  short,  in  hysteria,  as  in  neurasthenia,  one  must  take  into 
account  the  real  fatigue  of  the  nervous  centers,  which,  on  one 
hand,  results  directly  from  morbid  states  of  mind,  and,  on  the 
other,  furnishes  new  food  for  autosuggestions.  Here  we  have 
the  eternal  vicious  circle,  in  which  the  neuroses  travel.  Their 
real  ills  give  birth  to  their  fears,  and  their  phobias,  and,  on 
the  other  hand,  their  mental  representations  of  a  pessimistic 
nature,  create  new  disorders.  I  admit  that  there  are  in  hys- 
teria very  real  functional  troubles — ailments  depending  on 
physical  causes,  and  painful  sensations  born  of  physical,  intel- 
lectual, and  emotional  fatigue.  But  it  is  just  as  plain  also  that 
these  sensations  sometimes  disappear  with  such  rapidity  that 
one  is  simply  obliged  to  attribute  a  psychic  origin  to  them, 
altho  it  may  not  always  be  possible  to  trace  the  association  of 
ideas  which  has  led  to  the  final  autosuggestion. 

Thus  we  can  hardly  dare  say :  "  We  call  those  symptoms 
hysterical  which  arise  through  the  medium  of  mental  repre- 
sentations." I  would  not  go  so  far;  and,  while  accepting  this 
definition  in  the  main,  I  would  limit  it  by  saying  that  divers 
somatic  symptoms  can  have  an  organic  origin,  and  yet  only 
be  produced  after  the  awakening  of  diseased  autosuggestions. 

I  will  remark,  furthermore,  that  to  obey  these  mental  rep- 
resentations is  not  the  exclusive  peculiarity  of  an  hysterical 
person.  The  neurasthenic,  the  hypochondriac,  and  the  mel- 
ancholiac  fall  into  the  same  fault.  We  have  already  seen  that, 
in  the  normal  man,  suggestibility  is  incommensurable. 

It  is  useless  to  make  an  effort  to  give  hysteria  the  character 
of  a  morbid  entity,  to  separate  it  artificially  from  neurasthe- 
nia, with  which  it  is  almost  always  combined.  It  will  often 
be  found  also  in  patients  with  evident  hypochondriacal  and 
melancholic  symptoms. 

Some  authors  have  said  that  neurasthenia  is  male  hysteria. 
It  is  false,  if  it  is  meant  by  that  that  hysteria  does  not  exist 
in  men.  But  there  is  some  truth  in  this  assertion.  Nervous- 


OF  NERVOUS   DISORDERS          181 

ness  in  the  adult  man  takes  the  form  of  neurasthenia  by  the 
very  virtue  of  his  masculine  mentality.  The  logical  faculties 
are  more  developed  in  man,  perhaps  from  the  very  fact  of  his 
physiological  organization,  perhaps  thanks  to  the  education 
which  he  has  received.  He  does  not  accept  absurd  sugges- 
tions so  easily,  he  is  less  demonstrative  in  the  expression  of 
his  discomforts.  On  the  contrary,  he  has  not  the  habit  of 
resigned  suffering  as  strongly  as  the  woman  has;  he  is  more 
easily  discouraged,  as  is  shown  in  the  greater  frequency  of 
suicide  among  men.  It  is  sadness,  discouragement,  unsatis- 
fied longings,  and  lack  of  power  which  rule  him,  and  these 
are  the  characteristics  of  the  neurasthenic.  The  woman,  on 
the  other  hand,  has  a  more  infantile  mentality.  She  more 
often  shows  bravery  in  the  face  of  physical  and  moral  pain. 
And  yet  she  feels  keenly;  she  has  more  imagination,  and  sub- 
mits more  easily  to  the  yoke  of  mental  representations.  Also, 
as  I  have  said,  one  recognizes  the  characteristics  of  femininity 
in  men  who  are  decidedly  hysterical,  and  the  boy  is  chiefly 
attacked  by  this  psychoneurosis  before  puberty,  when  his 
place  is  still  in  the  women's  apartments. 

Tho  mild  in  its  lighter  forms,  which  seem  to  connect  it 
with  the  almost  amiable  nervousness  of  most  women,  hysteria 
may  become  severe  and  pass  without  transition  into  insanity. 
I  look  back  to  classic  treatises  for  the  description  of  innumer- 
able symptoms  of  major  hysteria.  I  take  it  for  granted  that 
they  are  well  known,  so  I  shall  limit  myself  to  general  con- 
siderations. In  the  majority  of  these  troubles  the  influence 
of  mental  representations  can  easily  be  recognized.  Charcot 
has  said :  "  We  must  take  hysteria  for  what  it  is — that  is  to 
say,  for  a  psychic  disease  par  excellence." 

Among  the  symptoms  of  hysteria  in  which  I  have  scarcely 
been  able  to  recognize  any  mental  origin  or  idiogenic  influence 
I  will  note  hysterical  fever,  a  phenomenon  that  is  more  frequent 
than  is  generally  believed.  One  often  observes  it  under  the 
form  of  fever  with  a  temperature  of  102-104°  F.,  so  that  it  is 
believed  to  be  a  question  of  an  acute  infection,  such  as  typhoid 
fever,  meningitis,  an  acute  attack  of  tuberculosis,  influenza, 
or  septicemia.  More  often  still  it  appears  as  a  mild  fever  of 


182  PSYCHIC   TREATMENT 

long  duration,  which  persists  for  months  or  years.  As  the 
patients  are  generally  thin  and  have  short  breath,  with  a  di- 
minished pulmonary  capacity,  and  as  they  often  cough  and 
may  have  hemoptyses,  the  first  diagnosis  which  one  is  apt  to 
make  is  that  of  tuberculosis.  When  we  have  made  this  diag- 
nostic suggestion  our  ears  become  more  acute,  and  it  then 
seems  to  us  that  the  respiration  is  weak  in  one  of  the  apices 
and  that  the  expiration  is  prolonged;  some  day  we  detect  a 
few  rales,  and  we  believe  that  we  have  elucidated  the  problem. 
But  at  the  end  of  a  few  weeks  doubts  spring  up  anew,  and 
auscultation  gives  such  insignificant  results  that  it  is  impos- 
sible to  use  them.  Little  by  little  the  situation  grows  clearer, 
and,  however  skeptical  we  may  have  been  concerning  this 
"  nervous  "  fever,  we  are  obliged  to  admit  its  existence. 

This  fever  strongly  resembles  the  hectic  fever  of  tubercu- 
losis; the  temperature  reaches  100-10x3.4°  F.  in  the  evening, 
and  sometimes  exceeds  this  by  several  tenths.  The  variation 
between  the  evening  temperature  and  that  of  the  morning  is 
generally  not  so  great  as  in  phthisis ;  also,  the  morning  fall  of 
temperature  is  not  so  distinctly  marked  by  profuse  perspira- 
tions. The  morning  temperature  often  exceeds  99.5°  F.  It 
seems  as  tho  one  had  to  do  with  a  normal  temperature, 
measured  with  a  thermometer  that  registers  a  few  tenths  too 
high.  The  patients  seem  more  indifferent  to  their  fever  than 
phthisical  patients.  They  are  often  ignorant  of  the  fact  that 
they  have  any,  and  when  some  day  the  temperature  rises  a 
few  tenths  they  do  not  detect  any  symptom  which  indicates 
an  aggravation.  I  have  seen  this  fever  grow  less  under  the 
influence  of  the  menstrual  period  or  a  passing  indisposition. 
There  is  an  analogy  in  this  to  what  happens  to  the  pulse  in 
Basedow's  disease ;  one  can  see  it  decrease,  and  fall  from  120 
to  90  and  80,  in  the  course  of  a  streptococcus  angina,  or  an 
intercurrent  affection,  even  when  the  latter  is  febrile. 

But  all  these  peculiarities  of  hysterical  fever  are  not  suffi- 
cient to  establish  the  diagnosis.  It  is  established  by  exclusion 
and  prolonged  observation  lasting  for  weeks  and  months,  dur- 
ing which  time  the  certainty  of  the  lung's  integrity  is  estab- 
lished. 


OF  NERVOUS   DISORDERS          183 

Hysterical  fever  generally  appears  in  the  course  of  severe 
hysteria  in  patients  who  have  convulsive  attacks  or  vomitings, 
various  pains  or  pareses,  and  who  present  the  stigmata  of 
hemianesthesia  and  narrowing  of  the  visual  field.  But  there 
are  exceptions,  and  I  have  been  able  to  observe  hysterical 
fevers  during  several  years  in  women  who  have  only  neuras- 
thenic symptoms,  in  which  impressionability,  emotional  states, 
and  a  pessimistic  state  of  mind  are  paramount. 

This  fever  can  stop  from  one  day  to  another,  under  the 
influence  of  a  joyous  emotion;  it  can  disappear  in  the  course 
of  a  psychotherapic  treatment,  without,  however,  the  possi- 
bility of  any  direct  suggestion  of  apyrexia.  But  there  are 
cases  where  this  fever  outlives  all  nervous  symptoms,  and 
persists,  even  when  the  patients  who  might  be  called  cured 
have  taken  up  their  habitual  routine  of  life.  I  have  had  under 
observation  patients  who  have  kept  up  this  strange  fever  for 
two  or  three  years. 

A  judicious  use  of  hypnosis  can  throw  a  little  light  on  the 
autosuggestive  genesis  of  certain  symptoms  in  hysteria.  It 
permits  a  somewhat  unreserved  inquiry,  and  leads  the  patient 
to  make  enlightening  revelations.  But  it  is  necessary  to  have 
a  great  deal  of  prudence  in  this  study,  and,  for  my  part,  as  I 
am  always  careful  of  agitating  my  patients  and  not  letting  them 
be  governed  by  the  imagination,  I  have  not  had  the  courage 
to  practise  this  moral  vivisection  upon  them. 

Hysteria  is  more  amenable  than  any  other  of  the  psycho- 
neuroses  to  a  purely  psychotherapeutic  treatment.  It  is  in 
this  very  common  affection  that  one  observes  those  sudden, 
instantaneous  cures  which  from  the  start  show  the  psychic 
nature  of  the  trouble.  Even  when  the  disease  reaches  the  point 
of  deserving  the  name  "  hysterical  insanity  "  the  delirium  is 
not  that  of  the  insanities,  properly  so  called ;  I  do  not  hesitate 
to  say  that  it  is  autosuggested.  This  is  why  one  sees  it  some- 
times suddenly  and  definitively  stopped  under  the  influence  of 
a  favorable  suggestion.  The  hysterical  patient  is  an  actress 
on  a  stage,  a  comedian,  but  never  reproach  her  with  it,  for  she 
does  not  know  that  she  is  acting ;  she  sincerely  believes  in  the 
reality  of  the  situations. 


184  PSYCHIC   TREATMENT 


CHAPTER   XV 

Melancholia  —  Danger  of  Suicide  —  Hypochondria :  Its  Milder  Forms 
Approach  Neurasthenia  —  Insufficiency  of  Nosographic  Classifica- 
tions —  Hypochondriacal  Melancholia  —  Minor  Hypochondrias  — 
Periodic  Depression  of  Lange 

THE  alienists  sometimes  shrug  their  shoulders  when  the 
neurologist  uses  the  terms  "  melancholia "  and  "  hypochon- 
dria." Their  manner  would  seem  to  say :  "  This  is  our  do- 
main ;  hands  off !  " 

I  am  always  ready  to  give  up  to  them  the  serious  cases 
which  require  confinement  in  asylums,  and  I  have  no  wish  to 
question  their  ability  in  making  a  diagnosis  and  pointing  out 
the  prognosis.  Moreover,  I  attribute  great  therapeutic  value 
to  a  sojourn  in  the  asylums;  the  patients  recover  their  calm- 
ness there,  and  they  are  subjected  to  firm,  gentle  discipline 
which  is  eminently  helpful  in  their  cure. 

But  when,  for  the  sake  of  information,  we  run  through 
the  classic  treatises  on  psychiatry,  we  are  somewhat  astonished 
at  the  confused  classification  which  we  find  there,  and  we 
have  some  difficulty  in  finding  out  what  we  want  to  know. 

Among  the  morbid  entities  which  we  find  therein  de- 
scribed, the  most  distinct,  and  the  most  clearly  outlined,  is 
that  of  melancholia,  which,  in  its  classic  forms,  is  easily  recog- 
nizable. 

Every  one  knows  these  patients  plunged  into  the  darkest 
depths  of  sadness,  sometimes  calm,  sometimes  agitated,  who 
give  expression  to  wandering  ideas  of  ruin,  both  moral  and 
physical.  Their  preoccupations  vary.  Sometimes  it  is  their 
position  in  the  world  which  is  compromised:  they  have  neg- 
lected their  patrimony  or  their  business,  their  wives  and  their 
children  are  in  the  deepest  misery;  sometimes  they  reproach 
themselves  for  their  past  Hfe  and  their  sins:  they  are  lost 


OF  NERVOUS   DISORDERS          185 

before  God,  they  have  failed  in  all  their  duties  to  their  own 
people. 

What  strikes  us,  first  of  all,  in  these  patients  is  the  te- 
nacity of  these  fixed  ideas,  when  there  is  nothing  to  confirm 
the  statements  of  the  patients ;  and,  also,  the  perfect  preserva- 
tion of  the  intellectual  faculties,  which  permits  them  to  reason 
logically  on  all  other  subjects.  Sometimes  the  ideas  that  they 
express  seem  to  have  a  certain  substratum  of  truth,  and  it  is 
difficult  to  tell  whether  their  fears  have  any  foundation  and 
whether  they  are  in  the  presence  of  real  difficulties.  This 
is  the  case  with  a  physician  who  claims  that  his  clientele 
grows  smaller  day  by  day,  of  the  merchant  who  says  that 
his  business  is  involved  and  that  all  he  has  will  be  lost.  When 
one  has  no  other  information,  we  may  wonder  whether  we 
have  to  do  with  a  sick  man  or  not.  But  more  often  the  exag- 
geration, whether  it  be  great  or  small,  is  evident,  and  the 
denials  of  relatives  show  the  wandering  nature  of  these  pre- 
occupations. 

At  other  times  the  madness  of  the  patient  is  recognized  at 
the  first  word.  Here,  the  mother  of  a  family  persists  in  be- 
lieving herself  six  months  enceinte,  when  she  has  her  periods, 
when  there  has  been  no  increase  in  the  size  of  her  breasts 
and  no  development  of  the  abdomen,  and  when  a  physician 
assures  her  that  the  uterus  is  of  normal  size.  Another,  and 
one  who  is  a  virtuous  matron,  accuses  herself  of  having  had 
relations  with  her  son,  and  of  having  led  the  life  of  a 
courtesan.  Another  patient  claims  that  he  is  losing  flesh  and 
fading  away,  that  he  is  nothing  but  skin  and  bones,  when  he 
is  in  a  state  of  normal  nutrition,  or  even  fat.  The  results 
of  successive  weighings,  which  indicate  an  increase  of  weight, 
do  not  succeed  in  convincing  him ;  and  with  an  outburst  of  in- 
dignation, or  commiserating  pity  for  our  blindness,  he  states 
no  one  has  any  sympathy  with  him.  Another  has  no  legs, 
no  muscles,  no  heart  (either  moral  or  physical),  no  stomach; 
his  brain  is  rotten,  he  smells  the  odor  of  putrefaction ;  he  sees 
his  coffin  prepared,  and  witnesses  his  funeral  preparations. 
But  the  terrible  thing  for  the  patient  and  his  family  and  his 
physician  is  that  the  danger  of  suicide  is  in  no  wise  in  pro- 


186  PSYCHIC   TREATMENT 

portion  to  the  apparent  intensity  of  the  delusional  idea.  One 
patient  who  groans  and  walks  up  and  down  his  room,  a  prey 
to  unspeakable  agony,  will  have  not  the  remotest  idea  of  sui- 
cide, while  another,  who  with  apparent  calm  tells  you  of  his 
annoyances,  or  who  complains  only  of  gastric  symptoms,  will 
kill  himself  as  he  goes  out  of  your  office. 

If  these  patients  were  seen  only  in  asylums,  if  they  were 
placed  there  immediately  at  the  start  of  their  illness,  I  would 
not  speak  of  them  here.  But  these  unfortunates  are  often 
sent  to  the  neurologists  under  a  false  label,  chiefly  the  con- 
venient one  of  neurasthenia.  In  many  cases  it  is  possible  to 
correct  this  diagnosis  and  to  resort  to  useful  measures ;  often, 
however,  it  is  unfortunately  too  late.  I  will  cite  a  few  ex- 
amples. 

A  physician  thirty  years  old  was  brought  to  me  by  his 
sister.  He  had  been  able  to  complete  his  studies  without 
hindrance,  altho  he  was  somewhat  slow.  He  had  his  diploma 
in  his  pocket.  As  his  aptitudes  did  not  seem  very  great,  his 
teachers  had  advised  him  to  establish  himself  in  the  country, 
where  he  would  more  easily  find  a  remunerative  clientele. 
He  did  not  follow  this  advice,  and  established  himself  in  a 
large  town,  where,  without  any  means  of  existence,  he  waited 
for  a  clientele  which  did  not  appear.  Then  he  became  plunged 
in  dispair,  and  wanted  to  leave  his  profession  and  go  into  the 
country  as  an  agriculturist. 

As  I  listened  to  this  recital  I  could  have  believed  that 
he  had  an  attack  of  neurasthenia,  sufficiently  explained  by 
mortification  at  his  failure.  But  the  appearance  of  the  patient 
struck  me.  He  had  a  depressed  appearance  and  an  unsteady 
look,  and  he  was  continually  uttering  little  moans.  His  idea 
of  doing  agricultural  work  seemed  to  me  absurd,  as  he  was 
born  in  the  city  and  was  a  complete  stranger  to  country  life. 

I  asked  the  sister  to  leave  the  patient  alone  with  me,  in 
order  to  permit  a  more  intimate  conversation,  and  I  asked  him 
pointblank  if  he  had  not  had  ideas  of  suicide.  He  acknowl- 
edged the  fact  immediately,  and  told  me  that  he  had  already 
at  home  prepared  a  solution  of  cyanide  of  potassium;  then, 
with  some  hesitation,  he  added  that  he  had  prepared  a  fresh 


OF  NERVOUS   DISORDERS          187 

one  at  Berne.  He  gave  me  the  bottle,  as  if  to  prove  to  me 
that  he  had  given  up  his  intentions. 

If  the  patient  had  belonged  to  our  country  I  would  not 
have  hesitated  to  commit  him  immediately,  but  he  was  a  for- 
eigner, and  I  could  only  advise  him  to  have  an  immediate  con- 
sultation with  the  alienist  of  his  native  town.  I  wrote  at 
once  to  his  family  physician,  but  the  patient  did  not  give 
time  to  take  the  necessary  measures,  for  he  climbed  over  the 
parapet  of  a  bridge  and  threw  himself  into  the  river. 

Another  case.  This  was  a  workman,  thirty-three  years 
of  age,  who  complained  of  fatigue,  distaste  for  food,  and 
burning  sensations  and  "  gnawing  "  in  the  stomach.  All  this 
he  attributed,  with  a  persistence  which  suggested  a  fixed  idea, 
to  the  valerian  and  massage  and  cold  baths  which  were  pre- 
scribed for  him  for  his  neurasthenia.  It  was  not  possible  to 
convince  him  of  the  innocuous  character  of  these  methods 
of  treatment.  He  persisted  in  accusing  his  physicians  of  hav- 
ing made  him  sick.  He  did  not  sleep  because  of  the  terrible 
"  burnings  in  his  stomach." 

On  examination  I  found  nothing.  The  patient  was  well 
nourished  and  did  not  have  a  coated  tongue.  I  told  him  that 
the  whole  trouble  was  nervous,  and  that  he  ought  to  let  him- 
self be  treated  by  a  physician  in  the  town  in  which  he  lived 
who  was  an  expert  in  these  disorders. 

He  seemed  calmed,  and  went  away  with  a  note  addressed 
to  my  confrere  who,  tho  the  patient  did  not  know  it,  had 
charge  of  a  small  asylum  for  the  insane.  I  sent  it  with  the 
diagnosis  of  confirmed  melancholia  of  the  hypochondriacal 
type,  and  I  urged  my  confrere  to  watch  him  and,  as  soon  as 
it  became  necessary,  to  arrange  for  his  entrance  into  the 
asylum.  While  his  wife  went  to  the  physician's  house  the 
patient  hanged  himself  in  the  kitchen. 

There  are  many  such  cases  which  present  merely  symptoms 
of  discouragement  or  functional  gastric  troubles,  such  as  may 
deceive  the  physician  and  lead  him  to  diagnose  a  simple  neur- 
asthenia, when  a  more  profound  psychological  analysis  would 
lead  to  the  recognition  of  a  fixed  idea  of  ruin  and  organic 


188  PSYCHIC  TREATMENT 

disorganization  out  of  all  proportion  to  the  real  condition  of 
the  patient,  or  to  his  bodily  condition. 

Along  with  melancholia  they  used  to  class  a  morbid  entity 
which  seemed  well  established — that  of  hypochondria.  To-day 
it  seems  to  have  disappeared,  and  alienists  who  have  paid  a 
great  deal  of  attention  to  the  classification  of  the  psychoses  do 
not  devote  even  a  special  chapter  to  it.  Thus,  Kraepelin  speaks 
of  hypochondria  either  as  a  symptom  of  what  he  calls  chronic 
nervous  exhaustion,  or  as  a  syndrome  of  neurasthenic  insanity. 
He  describes  it  in  degenerates  and  in  old  people,  where  it  is 
allied  with  melancholia,  and  in  hysterical  persons.  There  is 
no  longer  any  malady  called  hypochondria.  There  are  only 
hypochondriacal  symptoms,  which  are  manifested  in  the  course 
of  various  psychopathic  states. 

It  seems  to  me  that  the  close  relation  which  unites  hypo- 
chondria to  melancholia  has  not  been  sufficiently  indicated. 
Melancholia  seems  to  me  to  be  a  psychosis  in  which  mental 
depression  and  sadness  are  dominant,  and  where  there  arise 
ideas  of  ruin  or  failure,  and  fixed  ideas  without  any  real 
ground,  which  finally  find  expression  in  delirium,  or  become 
otherwise  more  or  less  markedly  exaggerated.  I  would  call 
"  hypochondria  "  the  condition  of  the  patient  whose  naturally 
melancholy  preoccupations  are  centered  chiefly  upon  his  health, 
and  upon  the  workings  of  his  organs.  In  both  cases  the 
patient  is  tormented  by  gloomy  preoccupations,  but  they  bear 
upon  different  subjects. 

These  hypochondriacal  sufferings  may  be  confined  to  one 
organ,  and  thus  constitute  one  of  the  fixed  algias  (pain  in 
the  abdomen,  between  the  shoulders,  pain  in  the  rectum,  or 
in  any  part  whatsoever).  The  trouble  may  consist  in  a  fear 
of  diseases,  in  the  tendency  to  believe  one's  self  afflicted  by  all 
the  ills  that  one  hears  spoken  of,  without  any  tendency  on  the 
part  of  the  patient  to  appear  actually  melancholy.  Thus,  while 
we  pity  without  any  question  the  true  melancholiac,  we  laugh 
at  the  hypochondriac  and  often  treat  him  brusquely.  He  is 
the  malade  imaginaire  of  Moliere. 

I  wish  very  much  that  this  were  a  condition  at  which  we 
could  afford  to  smile,  altho  it  is  never  charitable  to  laugh  at 


OF  NERVOUS   DISORDERS          189 

those  who  are  suffering.  Imaginary  or  not,  their  troubles 
are  bad  enough  and  very  real  to  them. 

But  there  is  a  common  form  to  which  one  could  apply, 
indifferently,  the  name  of  melancholia  or  hypochondria.  Its 
characteristic  is  that  the  preoccupations  of  the  patient  have 
to  do,  as  in  classical  hypochondria,  with  the  organs  and  their 
functions. 

These  patients  are  not  afflicted  with  the  idea  of  ruin  and 
of  guilt  before  God  or  before  men ;  they  do  not  accuse  them- 
selves of  any  misdeed  or  sin;  they  do  not  express,  concerning 
their  position  in  the  world,  any  queer  idea  which  would  enable 
one  to  recognize  the  insane  nature  of  their  trouble.  They 
only  complain  of  what  appear  to  be  physical  disorders,  such 
as  a  bitter  taste  in  the  mouth,  a  burning  sensation  of  the  tongue, 
risings  and  burning  in  the  stomach,  rumbling  in  the  bowels, 
and  flatulency;  and,  as  all  these  troubles  may  exist  without 
any  disturbance  of  the  intellectual  faculties,  we  are  at  a  loss 
to  see  where  the  psychopathy  comes  in. 

However,  the  patient's  tendency  to  exaggeration  gives  us 
the  clue.  Their  complaints  are  out  of  all  proportion  to  the 
cause,  and  on  questioning  the  patient  we  discover  I'angoisse 
precordiale — the  mental  agitation  which  forces  the  patient  to 
get  out  of  bed  and  walk  for  hours  in  his  room.  We  detect 
melancholia  in  his  anxious  look  and  depressed  appearance, 
and  often  we  can  get  him  to  confess  that  he  has  had  an  idea  of 
suicide — not  only  that  vague  longing  for  death  which  is  so 
often  seen  in  nervous  people,  but  that  irresistible  impulse 
which  has  already  led  the  patient  to  choose  the  means  by 
which  he  would  take  his  life,  and  which  has  impelled  him 
to  make  a  serious  attempt. 

Whether  the  alienists  call  these  conditions  melancholia  or 
severe  hypochondria,  or  whether,  taking  into  account  the  kind 
of  preoccupations  of  the  patient,  they  decide  to  make  it  a 
mixed  form  of  "  hypochondriacal  melancholia,"  it  is  all  the 
same  to  me.  We  are  dealing  here  with  serious  conditions 
which  are  often  incurable,  and  which  almost  always  demand 
confinement  in  asylums;  even  in  the  cases  which  end  in  a 
cure  we  must  always  be  afraid  of  a  relapse. 


190  PSYCHIC  TREATMENT 

But  the  difficulty  comes  in  when  we  have  to  deal  with  the 
milder  forms,  with  patients  who  refuse  to  consult  an  alienist, 
and  turn  to  the  general  practitioner  or  the  neurologist. 

It  is  then  that  one  realizes  how  vague  the  classifications 
are,  and  of  how  little  use  it  is  to  try  to  create  morbid  entities 
in  mental  medicine,  because  we  have  more  or  less  succeeded 
in  doing  so  for  bodily  illnesses. 

Without  doubt,  scarlet  fever  and  measles  are  morbid  en- 
tities, just  as  much  as  those  infectious  diseases  whose  micro- 
organism we  know  and  we  cultivate.  And  it  is  the  same  with 
regard  to  the  greater  number  of  organic  affections,  even  when 
we  are  still  in  the  most  complete  ignorance  of  their  pathogeny. 

But  the  moment  we  approach  psychic '  territory  this  re- 
spect for  classification  is  no  longer  possible.  Without  sup- 
pressing those  names  that  usage  has  endorsed,  without  giving 
up  analysis,  without  being  afraid  to  establish  still  further  sub- 
classes as  the  result  of  a  more  precise  study  of  the  symptoms, 
we  are  compelled  to  work  synthetically,  and  to  abolish  arbi- 
trary distinctions.  It  is  not  that  we  must  see  less,  it  is  that 
we  must  look  at  things  from  a  higher  plane. 

It  is  only  then  that  we  shall  be  enabled  to  discern  neuras- 
thenias of  so  light  a  character  that  we  shall  recognize  in  these 
patients  nothing  but  the  common  weakness  of  humanity,  and 
to  confess  cheerfully :  "And  I,  too,  I  am  neurasthenic !  " 

We  shall  even  dare  to  insinuate  that  all  ladies  are  hysterical 
while  we  tell  them  that  they  are  only  "  nervous,"  and  this  skin- 
deep  nervousness  becomes  them  very  well  and  constitutes 
one  of  the  charms  of  their  femininity. 

And  then  we  shall  see  that  all  the  hysterical  people  are  also 
neurasthenic,  that  many  neurasthenics  are  slightly  hypochon- 
driacal,  that  there  are  symptoms  of  melancholia  in  all  these 
patients;  and  at  last,  when  we  reach  the  class  of  degenerates, 
we  shall  be  obliged  to  put  all  these  unfortunates  into  it;  and 
if  we  do  not  enter  with  them  the  hall  to  which  we  have  destined 
them,  we  are  nevertheless  in  the  antechamber. 

But  it  is  not  the  names  which  matter;  the  diagnosis  does 
not  make  the  disease.  What  is  essential,  in  fact,  is  the  prog- 
nosis, and  it  is  here  that  serious  difficulties  occur,  because  on 


OF  NERVOUS   DISORDERS          191 

the  judgment  of  the  physicians  depend  the  measures  that  are 
to  be  taken.  As  for  the  patient,  any  use  of  a  word  derived 
from  the  Greek  is  a  matter  of  indifference  to  him,  our  noso- 
graphic  discussions  can  scarcely  be  expected  to  interest  him. 

There  is  a  much  more  urgent  problem  to  solve,  and  that  is, 
What  is  to  be  done  in  the  matter  ?  This  is  the  point  on  which 
synthetic  views  are  more  useful  than  a  short-sighted  analysis. 
There  are  melancholias  which  require  immediate  committal  to 
confinement  or  treatment  with  unremitting  surveillance — not 
"  because  it  is  a  melancholia,"  but  because  there  is  danger  of 
suicide.  There  are  cases  where  this  impulse  is  wanting,  but 
where  the  delirious  ideas  are  so  firmly  rooted  and  so  absurd 
in  their  origin  that  one  must  expect  them  to  be  of  long 
duration  (that  is,  of  several  months),  then  the  sojourn  in  an 
asylum  is  also  indicated.  There  is  vesanic  melancholia — that 
in  which  the  public,  whose  intuition  is  often  valuable,  recog- 
nizes insanity. 

But  alongside  of  these  sad  conditions,  which,  happily,  are 
often  curable,  there  is  mild  melancholia — hypomelancholia,  as 
some  authors  style  it.  In  many  cases  it  does  not  go  beyond 
the  limits  of  neurasthenia.  The  discouragement  is  more  or 
less  resultant;  the  patient  has  suffered,  has  had  annoyances 
which  have  come  upon  him  at  a  time  when  fatigue  and  over- 
strain had  diminished  his  vital  energy.  A  little  rest  and  a 
few  conversations  with  the  physician,  who  has  made  himself 
the  patient's  friend,  is  sufficient  to  dissipate  all  his  troubles. 

Sometimes,  however,  the  trouble  is  more  serious.  There 
are  not  only  sadness  and  discouragement  and  gloomy  ideas, 
but  there  are  false  ideas  and  genuine  melancholia  already  of 
an  insane  character;  nevertheless,  the  trouble  will  yield  to  the 
same  measures. 

A  confrere  thirty-four  years  of  age  was  overworked  for 
several  months.  He  felt  his  strength  grow  less  and  his  mood 
become  gloomy.  In  addition  to  this,  he  lost,  by  an  embolism, 
a  patient  on  whom  he  had  operated  with  success.  The  acci- 
dent occurred  twelve  days  after  treatment,  without  there  hav- 
ing been  any  fault  in  the  operation,  and  just  as  the  patient 
was  cured  and  about  to  leave  the  hospital.  What  was  the 


192  PSYCHIC   TREATMENT 

result  ?  Our  friend  was  plunged  into  melancholia,  he  was  con- 
vinced that  it  was  the  end  of  his  medical  career,  that  no 
confrere  would  hereafter  trust  any  operative  cases  to  him. 
Having  had  to  give  his  advice  in  a  desperate  case  where  death 
occurred  during  the  operation,  he  did  not  take  any  account  of 
the  fact  that  he  was  only  very  indirectly  the  cause  of  the  inter- 
vention, and  he  tormented  himself  over  it  infinitely  more  than 
the  physician  who  had  the  responsibility  of  the  operation. 

Now  this  was  not  a  case  of  ordinary  discouragement,  such 
as  we  may  all  feel  during  agitated  periods  of  a  physician's 
life.  No;  he  was  profoundly  persuaded  that  his  reputation 
was  lost;  he  questioned  his  fellow  physicians  to  find  some 
remote  corner  in  the  country  where  he  could  finish  his  days 
like  an  animal  that  is  mortally  wounded.  In  spite  of  his  de- 
pression, he  languidly  continued  his  work,  then  he  came  to  con- 
fide to  me  not  his  symptoms,  for  he  did  not  think  himself  sick, 
but  his  legitimate  preoccupations.  I  tried  to  dissipate  them, 
to  show  him  the  foolishness  of  his  fears,  but  he  could  not  un- 
derstand how  I  could  be  so  lacking  in  perception,  how  I  could 
thus  deny  the  evidence.  He  insisted  that  he  was  lost  forever. 
Unfortunately  for  my  demonstration,  there  was  some  little 
truth  in  what  he  said  concerning  his  clientele.  There  had 
been  a  falling  off,  due  to  the  season  of  the  year  and  to  absence 
of  soldiers  on  military  service,  and  to  certain  wholly  fortuitous 
circumstances.  But  my  patient  would  not  admit  these  ex- 
planations. His  position  was  compromised  by  the  failure  of 
his  operation,  by  his  conduct  with  his  patients  and  his  con- 
freres. The  fixed  idea  persisted  in  all  its  distinctness.  It  was 
still  more  distinct  when  he  spoke  of  his  financial  situation. 
It  was,  I  know,  more  than  good ;  he  could  have  lived  modestly, 
if  necessary,  without  working.  But  he  could  not  see  things 
in  this  light.  The  situation  was  desperate,  his  wife  and  his 
children  were  reduced  to  beggary;  he  ought  never  to  have 
married;  he  had  brought  misfortune  on  his  family.  He  felt 
himself  so  unworthy  that  he  even  dreamed  of  suicide. 

In  a  consultation  with  two  other  physicians,  one  of  whom 
was  an  alienist,  the  patient  opposed  our  reasonings  with  ab- 
solute conviction;  he  was  astonished  to  see  physicians  whom 


OF   NERVOUS    DISORDERS          193 

he  cared  for  and  whom  he  knew  to  be  serious  persist  in  such 
a  fatal  mistake. 

The  diagnosis  of  unquestioned  melancholia  was  pronounced, 
and  we  unanimously  advised  the  patient's  voluntary  entrance 
into  a  private  asylum.  He  acquiesced  without  any  difficulty, 
and,  the  proceedings  being  over,  he  was  about  to  go  away 
when  I  was  seized  with  misgivings.  Were  we  quite  wise  in 
what  we  were  going  to  do?  Would  not  this  residence  in  an 
asylum  give  new  food  to  his  conviction  of  ruin?  Cured,  per- 
haps, he  might  be,  but  would  he  not  have  the  feeling  that 
this  confinement  had  lowered  him  in  public  esteem? 

I  interrupted  the  patient  in  his  plans,  I  proposed  to  him  a 
treatment  which  consisted  in  staying  in  bed  and  taking  psycho- 
therapic  treatment.  Without  insisting  too  much  at  first,  for 
fear  of  combatting  his  fixed  ideas,  I  showed  him  how  sure 
we  all  were  that  he  was  mistaken,  and  that  he  was  really  sick. 
He  seemed  appreciative  and  touched  by  my  good  intentions, 
but  he  did  not  seem  to  be  seriously  shaken  in  his  purpose. 

As  I  was  obliged  to  go  away  for  three  weeks,  I  turned  him 
over  to  a  brother  physician  who  patiently  continued  this  work 
of  persuasion,  and  from  a  distance  I  wrote  the  patient  a  few 
encouraging  letters.  On  my  return,  only  three  weeks  after 
the  beginning  of  the  treatment,  I  found  him  absolutely  free 
from  all  his  peculiar  ideas.  He  acknowledged  without  hesi- 
tation that  we  were  right,  and  failed  to  understand  how  he 
could  have  had  such  ridiculous  ideas.  He  was  already  able 
to  laugh  over  it,  and  he  was  delighted  to  have  escaped  the 
asylum.  The  only  thing  left  was  a  little  insomnia  and  a  slight 
irritability  with  those  around  him,  but  a  few  weeks  afterward 
he  returned  to  his  practise  and  to  his  work,  completely  cured. 

This  is  an  extreme  case.  Theoretically,  the  patient  was 
ripe  for  the  asylum;  the  idea  of  suicide  had  germinated,  and 
confinement  might  seem  urgent.  One  is  perfectly  right  in 
believing  that  such  a  condition  would  last  three  months,  six 
months,  or  even  a  year.  Well,  no.  It  lasted  a  few  weeks, 
and  soon  the  patient,  who  seemed  rebellious  to  all  reason, 
gave  in  to  persuasion;  at  the  same  time,  rest  and  good  food 


194  PSYCHIC   TREATMENT 

improved  his  general  condition,  and  it  ended  in  a  complete 
cure. 

The  position  of  the  physician  in  these  varied  cases  of 
melancholia  is  difficult.  In  a  case  which  seems  mild,  suicide 
may  take  place  all  at  once,  and  the  practitioner  ought  never 
to  forget  the  words  of  Gudden,  who  perished  with  the  king 
of  Bavaria  because  he  himself  transgressed  this  rule :  "  Never 
trust  a  melancholiac." 

I  acknowledge  the  truth  of  this  dictum,  but,  nevertheless, 
there  are  exceptions,  and  it  would  be  very  sad  if  they  should 
cram  all  the  unfortunates  into  the  asylum.  There  are  some 
that  can  be  treated  by  the  gentlest  measures.  It  is  on  these 
occasions  that  the  physician  ought  to  have  tact;  that  delicate 
perception  that  the  most  complete  medical  instruction  can  not 
give.  Alas!  even  tact  and  delicate  perception  sometimes  fail, 
and  the  physician  finds  himself  compelled  to  say :  "  Do  con- 
scientiously what  you  feel  to  be  your  duty,  come  what  may." 

An  analogous  situation  is  found  in  hypochondria.  There 
is  insane  hypochondria,  most  frequently  incurable,  which  may 
accompany  melancholia  or  give  rise  to  it,  and  likewise  often 
ends  in  suicide.  But  sometimes,  at  least  during  a  certain  period, 
the  patients  are  not  at  all  melancholy,  in  the  common  sense 
of  the  word.  There  are  some  who,  in  regard  to  the  incurable 
disease  with  which  they  believe  themselves  to  be  attacked, 
manifest  a  calm  stoicism. 

A  man  seventy  years  of  age  was  brought  to  me  by  his 
relatives  as  a  neurasthenic.  After  half  an  hour's  conversa- 
tion with  the  patient,  I  said  to  the  relatives :  "  You  bring 
your  patient  to  me  under  a  wrong  label;  he  is  afflicted  with 
serious  hypochondria,  and  his  place  is  in  an  asylum."  This 
prospect  did  not  please  the  family,  and  they  begged  me  to  keep 
the  patient  under  observation,  in  bed,  and  under  surveillance. 
I  assented,  and  during  two  months  the  fixed  idea  persisted 
without  the  slightest  change. 

The  patient  was  persuaded  that  he  had  an  abdominal  can- 
cer, and  when,  after  long  and  repeated  examinations,  I  told 
him  that  he  had  not  the  slightest  symptoms  of  this  affection, 
and  declared  myself  absolutely  in  accord  with  the  two  phy- 


OF  NERVOUS    DISORDERS          195 

sicians  who  had  seen  him.  "before  me,  he  replied,  with  a  smile 
that  was  slightly  cunning :  "  Oh,  you  know  very  well  that  I 
have  one,  but  you  do  not  want  to  tell  me  so !  " 

I  returned  to  the  patient  and  said  to  him :  "  But,  my  dear 
sir,  if  you  had  a  cancer  I  would  not  keep  you.  I  only  take 
care  of  nervous  people.  I  should  have  immediately  turned 
you  over  to  a  surgeon."  "  Oh,  you  will  very  soon  send  me 
back  home  to  die,  but  you  do  not  want  to  trouble  me.  That 
is  why  you  make  such  an  effort  to  prove  to  me  that  I  have 
no  cancer !  "  For  two  months  he  made  always  the  same  calm 
answers,  emphasizing,  without  any  marked  sadness,  a  simple 
fixed  idea.  Later,  when  he  was  confined  in  an  asylum,  he 
tried  to  open  the  abdomen.  I  do  not  know  how  he  ended. 

At  the  same  time  while  this  hopeless  patient  was  with  me,  I 
took  care  of  a  young  man  thirty-six  years  of  age  who  could 
be  equally  described  as  hypochondriacal. 

He  had  suffered  from  nervous  dyspepsia,  had  undertaken 
several  unsuccessful  treatments,  and  came  to  complete  at 
Vichy  a  treatment  on  which  he  had  based  great  hopes.  He 
returned  from  it  as  despondent  as  before,  and  persuaded  him- 
self that  he  had  a  cancer. 

At  the  beginning  my  assurances  that  he  had  no  cancer  met 
the  same  resistance  as  in  the  preceding  subject,  but  sometimes 
I  detected  in  his  look  an  expression  of  hope.  It  was  a  very 
little  thing,  and  certainly  persons  who  are  strangers  to  the 
medical  art  would  have  found  my  two  hypochondriacs  each 
as  sick  as  the  other. 

I  put  my  patient  on  a  milk  diet  for  six  days,  then  on  a 
period  of  overfeeding,  which  rapidly  produced  an  increase  of 
bodily  weight.  Then,  but  only  then,  the  patient  began  to 
doubt  his  cancer.  The  idea  did  not  disappear  altogether 
until  the  end  of  a  few  weeks.  At  the  end  of  two  months  the 
patient  was  in  perfect  psychic  and  physical  health,  and  has 
not  relapsed. 

Here  was  a  mild  hypochondria,  such  as  one  could,  without 
straining  matters,  put  into  the  pigeonhole  of  neurasthenia 
were  it  not  already  so  full. 

There   are  some   forms   still   milder,   which   are   curable 


196  PSYCHIC   TREATMENT 

in  a  few  conversations.  These  are  hardly  more  than  the 
weak-minded  state  or  hypochondriacal  disposition  compatible 
with  a  condition  of  health,  which  one  often  observes.  I  mean 
in  those  people  who  are  afraid  of  the  least  hurt,  who  consider 
themselves  phthisical  when  they  have  a  cold,  who  imagine 
they  have  cancer  of  the  stomach  the  moment  they  feel  a  slight 
heaviness  in  the  epigastrium,  who  believe  themselves  tabetic 
because  they  have  staggered  a  little  in  walking.  Physicians 
and  medical  students  are  subject  to  this  infirmity.  It  is  often 
passing;  but,  take  care,  and  do  not  let  these  phobias  grow. 
When  any  one  goes  mad  he  does  so  along  the  lines  of  his 
former  mentality,  and  I  have  found  toward  the  fifties  symp- 
toms of  very  serious  hypochondria  in  fellow  physicians  who, 
during  their  student  period,  had  merely  showed  a  weak-mind- 
edness which  exposed  them  to  the  jests  of  their  comrades. 

The  Italians  have  a  word  to  describe  these  people  who  are 
always  disturbed  over  their  health.  They  call  them  salutista, 
from  salute,  which  means  health.  The  word  indicates  some- 
thing less  than  hypochondria,  and  I  have  been  glad  to  know 
it  in  order  to  say  to  my  patients :  "  The  best  way  to  disturb 
your  health  is  just  to  worry  about  it — to  be,  in  a  word, 
'  salutista' " 

Under  the  name  of  "  periodic  depression,"  Professor  Lange, 
of  Copenhagen,  described,  in  1885,  some  conditions  of  mental 
weakness  which  occur  at  certain  periods.  The  periodicity  is 
not  regular,  and  Lange  indicates  a  duration  of  three  to  six 
months  for  the  time  of  depression.  The  interval  of  health 
may  last  six  months  to  a  year.  He  attributes  this  condition 
to  the  uric  acid  diathesis,  and  strives  to  combat  it  by  an  anti- 
arthritic  regime  which,  however,  has  not  yet  given  appreciable 
results. 

In  reading  this  description  I  have  easily  recognized  psycho- 
pathic states  which  are  common  in  our  country  also,  but  yet 
I  have  been  astonished  to  see  that  Lange  has  observed  two 
thousand  of  such  cases  in  the  space  of  ten  years.  When  one 
finds  so  quickly  such  a  number  of  cases  of  a  newly  described 
disease  it  occurs  from  the  fact  that  the  author  has  made  a 


OF  NERVOUS   DISORDERS          197 

change  in  terminology.  He  merely  takes  the  disease  out  of  one 
pigeonhole,  or  out  of  several,  and  puts  it  into  another. 

It  was  at  one  time  the  fashion  to  consider  this  a  form  of 
melancholia.  I  consider,  with  Lange,  that  this  is  a  mistake. 
These  sufferers  from  periodic  depression  have  merely  low 
spirits,  a  condition  that  goes  with  bad  temper  and  indecision, 
but  they  never  have  the  delusional  ideas  of  the  melancholic 
patient,  and  fortunately  their  trouble  does  not  develop  in  the 
same  way  that  melancholia  does. 

It  is  rather  from  the  list  of  neurasthenias  that  Lange  has 
borrowed.  His  publication  is  of  great  interest,  in  that  it  has 
called  attention  to  the  periodicity  of  these  relatively  mild 
psychopathic  conditions.  I  will  return  later  to  a  consideration 
of  this  periodicity  in  the  psychoneuroses  and  to  the  conclusions 
that  may  be  drawn  from  it. 

His  attempt  to  explain  depression  by  the  uric  acid  diathesis 
would  be  interesting  if  he  had  succeeded  in  proving  the  fact, 
either  by  chemical  researches  or  by  the  effects  of  his  thera- 
peutics. But  he  has  not  proved  the  existence  in  such  cases 
of  an  excess  of  uric  acid  nor  succeeded  in  curing  his  patients. 

The  pathognomonic  characters  of  this  condition  are  the 
feelings  of  heaviness,  fatigue,  and  inertia;  the  patients  are 
conscious  of  moral  and  physical  depression.  It  is  interesting 
to  know  that  sometimes  they  can  overcome  this,  and  that,  par- 
ticularly in  those  cases  where  the  occupation  to  which  they 
apply  themselves  is  mechanical,  they  have  a  tendency  to  con- 
tinue their  work  without  being  able  to  stop.  They  are  in  a 
state  of  inertia  which  prevents  them  from  stopping  just  as 
much  as  from  starting.  These  are,  in  short,  sharp  attacks  of 
neurasthenia,  in  which  the  prominent  features  are  lack  of  will- 
power and  physical  and  moral  helplessness. 


198  PSYCHIC  TREATxMENT 


CHAPTER   XVI 

Idea  of  Degeneracy:  Morel  and  Magnan — Mental  and  Bodily  Stigmata 
— Abuse  of  the  Idea  of  Degeneracy — Human  Imperfections :  Phys- 
ical. Intellectual,  and  Moral  Malformations — Relationship  of  the 
Different  States  of  Disequilibrium — Isolated  Nervous  Symptoms 

HITHERTO,  among  those  whom  we  call  neurasthenic  or 
hysterical,  we  have  demonstrated  the  existence  of  permanent 
physical,  intellectual,  and  moral  malformations — a  fact  which 
somestimes  leads  us  to  say :  "  These  people  are  degenerates." 
We  come  across  similar  blemishes  in  their  brothers  and 
sisters,  and  in  their  ancestors,  or  in  their  descendants.  They 
are  outcasts  who  deserve  our  compassion,  and  whom  the 
unpitying  world  often  treats  harshly.  In  noting  these  facts 
I  want  first  of  all  to  point  out  the  thread  that  binds  together 
all  of  these  psychoneuroses,  and  to  emphasize  the  importance 
of  heredity. 

But  we  have  limited  the  term  "  degenerates  "  particularly 
to  those  patients  in  whom  the  mental  disequilibrium  is  more 
profound,  and  we  have  tried  to  put  them  in  a  separate  class. 

The  psychircric  idea  of  degeneracy  is  due  to  a  French 
alienist,  Morel,  who  in  1857  published  his  Trait e  des  degenere- 
scences  de  I'esptce  humaine. 

He  defines  this  degeneracy  thus :  "  The  clearest  idea  that 
we  can  form  of  human  degeneracy  is  to  represent  it  to  our- 
selves as  an  unhealthy  deviation  from  the  primitive  type.  This 
deviation,  however  simple  we  may  suppose  it  at  its  beginning, 
carries  with  it,  nevertheless,  elements  of  transmissibility  of 
such  a  nature  that  whoever  bears  the  germ  of  it  becomes 
more  and  more  incapable  of  fulfilling  his  function  in  human 
pyistence  and  intellectual  progress,  already  dragged  down  in 
his  own  person,  finds  itself  still  further  threatened  in  his  de- 


OF  NERVOUS   DISORDERS          199 

scendants.  Degeneracy  and  unhealthy  deviation  from  the 
normal  type  of  humanity  are  then,  according  to  my  ideas,  one 
and  the  same  thing." 

Morel,  who  was  an  observer  of  the  first  order,  well  knew 
how  to  distinguish  in  these  facts  the  biological  law  of  heredity, 
but  completely  imbued  with  theological  ideas,  he  admitted, 
according  to  Genesis,  the  existence  of  a  perfect  human  type, 
and  looked  for  degeneracy  in  the  degradations  of  this  primi- 
tive being  endowed  with  all  perfections.  The  idea  of  a  fall 
and  of  original  sin  is  mingled  with  his  vague  conceptions  of 
determinism,  resulting  from  the  same  idea  of  heredity. 

He  does  not  forget  to  point  out,  alongside  of  atavistic  and 
hereditary  influences,  the  action  of  physical  agents  and  of 
intoxicants  which  can  lead  to  degradation.  He  also  applies 
the  epithet  "  degenerative  "  to  all  mental  diseases  which  he 
divides  into  six  principal  groups,  as  follows: 

1.  Hereditary   insanity. — Comprising    (a)    insanity,    which 
results  from  a  congenital  nervous  temperament;   (6)   moral 
insanity,  which  is  characterized  by  unruly  actions  rather  than 
by  any  disturbance  of  the  intelligence;  (c)  mental  weakness, 
subject  to  morbid  impulses  and  prone  to  commit  harmful  acts. 

2.  Toxic  insanity. — Comprising  (a)  insanity  caused  by  the 
ingestion  of  toxic  substances,  alcohol,  opium,  etc.;   (6)   that 
which  is  determined  by  insufficient  nourishment  or  food  of 
poor  quality;  (c)  that  which  proceeds  from  marshy  miasmas, 
or  geological  formation,  etc.,  such  as  cretinism. 

3.  Insanity  by  transformation   of   certain   neuroses. — Hys- 
terical insanity,  epilepsy,  hypochondriasis. 

4.  Idiopathic  insanity. — Progressive  weakening  of  the  fac- 
ulties, general  paralysis. 

5.  Sympathetic  insanity. 

6.  Dementia. — The  terminal  period  of  various  affections. 
Magnan  and  his  school  refuted  the  biblical  idea  of  a  normal 

human  type  and  of  original  sin,  seeking  to  better  define  the 
group  of  degenerates.  They  placed  together  a  number  of 
patients  afflicted  with  various  mental  troubles  that  had  been 
under  observation  for  a  long  time  without  seeing  the  bond 
that  united  them.  These  new  ideas  were  actively  discussed 


200  PSYCHIC  TREATMENT 

by  the  alienists  of  Paris  and  Berlin.  They  disputed  among 
themselves  on  the  value  of  the  hereditary  factor,  on  the  stig- 
mata which  characterized  degeneracy,  without  being  able  to 
arrive  at  any  agreement. 

The  following  table  of  Magnan 1  shows  the  extent  that 
he  gives  to  his  conception  of  mental  degeneracy: 

SYNOPTIC  TABLE  OF  MENTAL  DEGENERACIES 

THE   HEREDITARY  DEGENERATES 

I.  Idiocy,  imbecility,  mental  debility. 

II.  (Disequilibrated.)     Cerebral  anomalies.     Defect  of  equi- 
librium of  the  moral  and  intellectual  faculties. 
III.  Episodic  syndromes  of  heredity. 

1.  Insanity  of  doubt. 

2.  Fear  of  touching.     Aichmophobia    (aixw,  point). 

3.  Onomatomania. 

a.  The  agonizing  search  for  a  name  or  a  word. 

b.  Obsession  of  a  word  which  one  can  not  get  rid 

of  and  an  irresistible  impulse  to  repeat  it. 

c.  Fear  of  a  compromising  word. 

d.  Preserving  influence  of  a  word. 

e.  Swallowed  words  burdening  the  stomach. 

4.  Arithmomania. 

5.  Echolalia,    coprolalia,    with    motor    incoordination. 

(Gilles  de  la  Tourette.) 

6.  Exaggerated  love  of  animals.     (Insanity  of   anti- 

vivisectionists.) 

7- 

a.  Dipsomania  (  8fya,  thirst) . 

b.  Sitiomania   (rfm'a,  food). 
8. 

a.  Kleptomania,  kleptophobia  (the  mania  and  fear 

of  theft). 

b.  Oniomania    (o6viat  purchase).    Abnormal   de- 

sire to  spend  money. 

1  Magnan.    Recherches  sur  la  centres  nerveux,    Paris,  1893. 


OF  NERVOUS  DISORDERS         201 

9.  Mania  for  gambling. 

10.  Pyromania,  pyrophobia  (mania  and  fear  of  fire). 

11.  Homicidal  and  suicidal  impulses. 

12.  Anomalies,  perversions,  sexual  aberrations. 

a.  Spinal    (simple    reflex,    genitospinal    center   of 

Budge). 

b.  Posterior  cerebrospinal    (posterior  cortical  re- 

flex). 

c.  Anterior  cerebrospinal  (anterior  cortical  reflex). 

d.  Anterior  cerebral  (erotomanias,  ecstasies). 

13.  Agoraphobia,  claustrophobia,  topophobia. 

14.  Aboulia  (indecision,  due  to  mental  torpor). 

a.  Reasoning  mania.     Moral  insanity   (persecuted 

and  persecutors). 

b.  Primary  multiple  delirium,  polymorphus,  rapid, 

or  sometimes  of  long  duration,  without  de- 
termined evolutional  succession. 

(1)  Ambitious  delirium. 

(2)  Hypochondriacal  delirium. 

(3)  Religious  delirium. 

(4)  Delirium  of  persecution,  etc. 

c.  Systematic  delirium,  unique,  fixed,  without  ten- 

dency to  evolute  (analogous  to  an  obsession). 

d.  Maniacal    excitement,    depression,    and    melan- 

choly. 

So  much  for  the  mental  degeneracies.  There  is  too  much 
and  not  enough  in  this  long  enumeration:  too  much  if  we  are 
to  keep  a  clear  idea  in  our  head  and  have  an  exact  view  of 
a  clinical  picture ;  not  enough  if  we  want  to  catalog  the  various 
forms  of  obsession,  of  phobia,  and  numerous  peculiarities  of 
character. 

What  is  one  going  to  do  in  this  table  with  the  sexual 
perversions  that  are  so  varied  in  their  mysterious  psychology, 
and  with  this  attempt  at  medullary  or  cerebral  localization? 
The  whole  thing  is  premature,  to  say  the  least. 

And  then,  in  reading  this  table,  I  was  overcome  with  a 
sense  of  uneasiness  lest  we  might  all  be  degenerates!  Who 
has  not  had  the  obsession  of  a  word  or  some  form  of  onama- 


202  PSYCHIC  TREATMENT 

tomania  or  arithmomania  ?  What  of  the  people  who  have  had 
passing  symptoms  of  agoraphobia,  of  claustrophobia,  and  of 
topophobia,  in  which  we  should  have  to  include  hypsophobia 
(fear  of  great  height,  wrongly  called  vertigo). 

Mania  for  gambling,  sexual  aberrations,  and  dipsomania 
are  three  characteristics  which  at  one  fell  swoop  throw  into 
one  group  of  degenerates  a  good  part  of  humanity!  The 
drunkards  and  the  debauches  will  meet  the  English  antivivi- 
sectionist  old  ladies  in  the  same  class.  In  short,  let  us  decide 
and  join  the  group  ourselves,  for  we  all  of  us  have  our 
manias,  and  "  aboulia,"  this  stigma  number  14,  is  one  which 
we  all  have  more  or  less  at  certain  periods  of  our  life. 

Let  us  pass  to  the  corporal  stigmata  of  this  universal 
degeneracy.  I  quote  from  Dejerine:1 

"  The  more  striking  stigmata  are  those  which  affect  the 
bony  system,  and  for  a  long  time  observers  have  noted  along 
these  lines  the  deformities  of  the  skull,  producing  various 
types  of  microcephaly,  hydrocephaly,  acrocephaly,  plagio- 
cephaly,  scaphocephaly,  dolicocephaly,  and,  in  lesser  degrees, 
the  simple  exaggeration  of  the  cranial  protuberances  and- 
irregular  depressions. 

"  There  have  also  been  described  in  these  cases  anomalies 
in  the  internal  structure  of  the  bones,  in  their  mode  of  devel- 
opment, their  ossification,  and  their  sutures.  Even  the  entire 
skeleton  may  be  attacked,  the  face  may  be  asymmetrical,  the 
spinal  column  may  be  incurved ;  the  bones  of  the  limbs 
themselves,  affected  in  their  evolution,  may  present  all  the 
appearance  of  rachitis,  the  possible  existence  of  webbed  or 
supernumerary  fingers  has  been  noticed,  also  club  feet  of 
various  kinds,  as  well  as  flat  feet. 

"  The  muscular  system  develops  late  and  incompletely ;  the 
muscles  always  show  a  condition  of  flaccidity ;  they  may  even 
be  atrophied. 

"  The  digestive  apparatus  does  not  escape :  the  vault  of  the 
palate  is  asymmetrical,  sometimes  narrow  and  pointed;  the 
lips  are  often  thick;  simple  and  complicated  harelips  are 


1  Dejerine.    Lhiridiii  dans  les  maladies  nervtvses.    Paris,  1886. 


OF  NERVOUS   DISORDERS         203 

very  common ;  the  irregularly  placed  teeth  appear  late ;  their 
number  may  be  diminished,  and  they  decay  easily.  Prog- 
nathism  occurs  frequently." 

Let  us  condense  a  little. 

"  Digestive  functions  often  disturbed,  merycism,  hernias. 

"  As  to  the  respiratory  and  circulatory  systems :  pulmonary 
tuberculosis  and  vasomotor  troubles. 

"As  to  the  genito-urinary  system:  incontinence,  phimosis 
hypospadias,  late  descent  of  the  testicles,  vaginal  anomalies, 
and  disturbances  of  menstruation." 

And  we  are  not  yet  at  the  end. 

"Anomalies  of  the  skin:  obesity,  abnormal  distribution  of 
hair. 

"Alterations  of  the  eye:  strabismus,  deaf-mutism ;  deformi- 
ties of  the  ear:  adherence  of  the  lobe,  anomalies  of  the  helix. 
Stuttering  and  lisping.  At  last  the  nervous  system:  migraine, 
vertigo,  convulsions,  tics,  insomnia,  nightmares." 

Decidedly  this  is  too  much.  It  is  an  enumeration  of  all 
human  weaknesses,  physical,  intellectual,  and  moral,  and  the 
description  loses  its  value  because  it  contains  too  much. 

It  is  the  same  way  when  one  looks  for  the  causes  of  de- 
generacy. In  reading  the  vast  table  of  Dallemagne 1  one  finds, 
carefully  enumerated,  the  etiological  conditions  of  the  majority 
of  bodily  and  mental  diseases. 

Some  have  gone  still  further  in  this  extension  of  the  idea 
of  degeneracy,  and  Max  Nordau  has  not  hesitated  to  place  in 
the  class  of  degenerates  the  artists,  musicians,  novelists,  and 
poets,  of  whose  tendencies  he  does  not  approve.  From  this 
point  of  view  one  is  always  somebody's  degenerate. 

It  is  not  that  this  picture  of  human  miseries  has  been  over- 
drawn: on  the  contrary,  one  could  trace  it  still  more  dra- 
matically, but  the  wrong  is  to  apply  to  all  these  conditions  the 
term  of  degeneracy  without  insisting  on  the  possibility  of 
regeneration. 

The  word  degenerate  supposes  a  point  of  comparison.  One 
can  be  degenerate  from  one's  own  point  of  view:  that  is  to 


1  Dallemagne.    Digtneris  et  deslquilibrls.    Bruxelles  et  Paris,  1895. 


204  PSYCHIC  TREATMENT 

say,  in  relation  to  some  previous  situation.  We  may  be  so  in 
comparison  with  our  relatives  or  ancestors,  and  with  the 
people  who  surround  us,  and  to  whose  influence  we  are 
obliged  to  submit.  We  could,  in  fact,  be  degenerates  accord- 
ing to  the  idea  of  Morel  by  comparison  with  an  original 
human  type  endowed  with  all  the  perfections. 

When  a  young  man  who  seems  to  be  gifted  lets  himself 
sink  into  increasing  laziness,  indulges  in  gayety,  and  keeps 
low  company,  he  little  by  little  reaches  a  state  of  physical,  in- 
tellectual, and  moral  degeneracy.  We  recognize  in  his  kind 
of  life  the  determining  causes  of  this  decadence,  and  it  is  by 
practising  on  him  moral  orthopedia  that  we  may  perhaps  be 
able  to  bring  about  his  improvement. 

But  one  must  be  a  very  superficial  observer  to  find  the 
problem  so  simple.  Examine  your  degenerate,  your  stray 
sheep,  and  you  will  see  that  in  his  most  brilliant  periods  he 
already  bore  within  him  the  mental  defects  which  have  led 
on  to  his  fall.  He  was  weak-willed,  he  let  go  of  his  moral 
principles,  and  indulged  the  lower  instincts  of  self-gratification. 
Look  through  his  ancestry  and  you  will  find  analogous  faults 
in  the  father,  the  paternal  or  maternal  grandfather,  or  a  weak 
character  in  the  mother,  or  a  lack  in  educative  influence.  Is 
he,  then,  a  degenerate?  Yes,  if,  in  comparing  him  with  his 
relatives,  one  establishes  the  fact  of  an  increasing  decadence, 
if  there  is  a  tendency  to  get  worse;  but  often,  in  spite  of  its 
deformities,  the  branch  is  worth  more  than  the  tree,  and  we 
are  already  in  the  presence  of  a  start  toward  regeneration. 

Aristocratic  families,  those  of  the  middle  class,  and  the 
proletariat  may  degenerate  under  the  influence  of  numerous 
causes;  such  as  consanguineous  marriages,  mental  contagion, 
unfavorable  habits  of  life,  alcoholism,  and  poverty.  Heredity, 
as  much  as  exterior  circumstance,  plays  an  important  role 
here,  and  the  presence  of  this  inevitable  influence  casts  a 
shadow  over  the  prognosis.  It  is  here  that  it  is  of  value  to 
discover  the  physical  and  mental  stigmata  which  mark  this 
natural  deformity.  But  do  not  let  us  forget  that  the  physical 
defects  by  no  means  indicate  the  degree  of  the  psychical 
malady.  There  are  people  who  look  like  monkeys,  who  yet 


OF  NERVOUS   DISORDERS         205 

have  great  moral  and  intellectual  worth;  whereas  very  good- 
looking  fellows  may  be  moral  idiots. 

I  can  not  accept  at  all  the  idea  of  degeneracy  from  the 
type  of  the  superior  Adam.  Whatever  may  be  the  hypothesis 
which  one  adopts  concerning  the  origin  of  the  human  species, 
it  appears  very  certain  to  me  that  our  first  ancestors  were 
savages.  They  may  have  been  able,  in  their  life  in  the  open 
air,  to  have  developed  great  physical  powers  and  to  have  es- 
caped from  the  pathogenic  influences  which  result  from  living 
in  great  agglomerate  masses,  but  we  surpass  them,  without 
doubt,  from  the  mental  point  of  view. 

Humanity  is  continually  progressing,  and  it  seems  to  me 
rediculous  to  speak  of  its  degeneracy.  One  must  even  admit 
that  regeneration  gets  the  better  of  degeneracy.  If  it  were 
not  so,  the  human  race  would  already  have  reached  the  last 
degree  of  idiocy,  or  it  would  have  been  wiped  out  by  sterility. 

In  short,  what  we  experience  every  day  with  sick  people 
are  the  human  imperfections,  the  physical,  intellectual,  and 
moral  malformations  of  the  race.  They  are  not  growing  deg- 
radations, but  stops  and  backslidings  on  the  ascending  path 
of  perfection.  Sometimes,  under  the  double  influence  of  the 
laws  of  heredity  and  education,  we  find  that  the  deformity 
becomes  aggravated,  in  an  individual,  a  family,  a  caste,  a 
people,  or  a  race,  and  it  is  here  that  it  is  permissible  to  speak 
of  degeneracy.  It  may  end  in  the  extinction  of  the  family, 
but  it  can,  during  the  process,  have  its  times  of  arrest  and  of 
improvement.  The  word  "  degenerated  "  indicates  too  crudely 
the  idea  of  fatal  decadence.  It  suggests  a  pessimistic  prog- 
nosis, and  it  often  takes  away  from  the  physicians  the  courage 
to  undertake  an  orthopedic  treatment.  On  the  other  side,  the 
discussions  on  the  subject  of  degeneracy  have  had  the  advan- 
tage of  clearly  demonstrating  the  relationship  which  exists 
between  slight  nervous  troubles  and  the  more  serious  psycho- 
pathic conditions.  We  have  since  then  been  better  able  to 
understand  the  importance  that  we  must  attribute  to  our 
psychic  peculiarities,  to  our  defects  and  our  little  follies. 
Altho  slight  in  ourselves,  they  may  increase  like  a  snowball 
in  posterity,  and  this  idea  warns  us  not  to  neglect  the  treat- 


206  PSYCHIC   TREATMENT 

ment  of  psychic  anomalies.  Education  alone  can,  in  a  certain 
measure,  correct  what  heredity  has  created. 

We  watch  in  our  clientele  a  procession  of  psychopaths  of 
every  kind:  neurasthenics  plunged  into  despair,  incapable  of 
all  activity;  hysterics  tormented  with  peculiar  sensations; 
hypochondriacs  of  all  degrees ;  melancholiacs  who  have  already 
rooted  within  them  that  characteristic  idea  of  this  affection, 
the  obsession  of  incurability;  in  short,  unbalanced,  disordered 
people,  subjects  with  every  kind  of  fixed  ideas,  all  the  way 
from  those  that  we  sometimes  have  in  a  normal  condition,  as 
the  obsession  of  a  tune  or  a  number,  up  to  the  most  absurd 
or  the  most  frightful  delirious  ideas. 

In  all  these  patients  we  can  detect  the  preponderating  in- 
fluence of  the  inner  hereditary  mentality,  and  its  aggravation 
by  education  or  by  the  contagion  of  example.  We  see  the 
accentuation  of  a  defect  of  a  certain  subject  in  his  descendants 
and  its  continual  increase  resulting  finally  in  decadence.  But 
fortunately  the  same  influences  often  act  in  a  contrary  sense, 
and  we  can  help  along  the  reclamation  by  psychic  therapy.  We 
are,  it  is  true,  wholly  helpless  in  the  presence  of  physical  de- 
fects, but  we  can  do  a  great  deal  against  mental,  intellectual, 
or  moral  disorders. 

One  hardly  dares  to  say  it,  but  to-day  they  still  try  to 
cure  these  patients  by  physical  measures.  I  can  not  understand 
such  therapeutic  aberration. 

Not  all  these  patients  are  curable;  but  when  cure  is  pos- 
sible it  is  brought  about  by  education.  The  prognosis  de- 
pends, above  everything  else,  upon  the  good  sense  that  one 
finds  in  the  patient,  on  the  spark  of  moral  life  which  is  hidden 
under  his  unbalanced  acts.  Often  in  looking  at  him  closely 
one  finds  him  really  less  degenerate  than  he  appeared. 

When  the  fixed  idea  is  distinctly  absurd  and  wandering, 
it  is  often  incurable,  or  else  it  will  only  yield  little  by  little 
under  the  educative  influence  of  a  favorable  environment. 
But  when  there  is  still  some  appearance  of  logic  in  the  idea, 
when  the  patient  in  his  lucid  moments  can  grasp  the  irration- 
ality of  his  deductions,  victory  is  possible  in  the  space  of  a 


OF   NERVOUS   DISORDERS          207 

few  months  or  a  few  weeks.  Doubtless  relapses  are  frequent, 
but  psychic  treatment  can  lead  to  very  marked  improvement. 

There  are  patients  who  are  subject  to  strange  obsessions. 
They  are  afraid  that  they  will  throw  themselves  out  of  the 
door  of  a  car,  or  climb  over  the  parapet  of  a  bridge.  They 
are  afraid  that  they  will  throw  their  relatives  out  of  the  win- 
dow, or  will  wound  somebody  with  a  knife  or  a  gun.  There 
are  some  with  a  strong  impulse  to  open  their  veins.  But  if 
there  is  a  certain  attraction  in  such  things  it  is  really  a  phobia. 
It  tends  to  make  one  shrink  back  and  not  to  act. 

Nothing  quiets  these  patients  like  the  frequently  repeated 
statement  that  they  will  not  do  anything.  It  is  necessary  to 
show  them  the  vast  distance  there  is  between  the  impulse 
toward  suicide  and  murder  and  the  phobia  which,  however 
distressing  it  may  be,  is  a  safeguard.  One  must  keep  at  this 
education  of  the  mind  with  imperturbable  persistence,  and  use 
the  most  forceful  and  convincing  arguments  that  one  can  think 
of  to  correct  the  judgment  of  his  patient,  in  order  to  make 
the  strings  of  moral  feeling  and  reason  vibrate  in  unison. 

It  is  through  lack  of  courage  and  perseverance  that  we 
err  in  the  treatment  of  these  psychoneuroses.  We  wait  too 
long  to  distinguish  the  morbid  entities  that  bear  on  a  certain 
etiology  or  a  different  prognosis.  We  do  not  see  clearly  enough 
the  bond  which  unites  these  different  affections. 

As  theorists,  let  us  work  on  the  nosographical  analysis, 
let  us  classify  according  to  symptoms,  according  to  etiological 
factors,  let  us  seek  to  make  the  symptomology  exact,  to  fix 
the  boundaries  of  the  syndromes,  let  us  establish  classes  and 
sub-classes;  but,  when  we  become  practitioners,  let  us  try  to 
forget  these  classifications  which  at  best  are  artificial  and 
variable.  In  therapeutics  one  must  know  how  to  be  synthetic 
without  neglecting  analysis. 

And,  above  all,  do  not  let  us  forget  the  end  in  view  (the 
improvement  of  the  patient),  which  we  too  often  abandon  to 
the  charlatan,  who  is  more  patient  as  well  as  more  headstrong 
in  his  ignorance  of  pathology. 

Along  with  these  more  or  less  well-determined  psycho- 
neuroses  to  which  one  can  regularly  apply  psychotherapy. 


208  PSYCHIC  TREATMENT 

there  exist  a  host  of  isolated  nervous  symptoms  which  it  is 
impossible  to  classify,  but  which  are  often  amenable  to  the 
same  measures.  I  mean  the  various  neuralgias,  myoclonies, 
spasms,  different  digestive  troubles,  and  genito-urinary  dis- 
orders, which  seem  independent  of  a  state  of  generalized  psy- 
choneurosis.  Almost  always,  however,  a  close  and  prolonged 
observation  centered  on  the  patient's  mind,  on  the  occasional 
causes,  frequently  moral  in  their  nature,  which  lead  to  the 
crisis,  enables  us  to  detect  the  psychopathic  mentality  of  the 
subject. 

I  will  add  that  even  in  the  treatment  of  organic  affections, 
which  demand  a  physical  or  medicinal  treatment,  the  pa- 
tient's condition  of  mind  is  often  modified  by  a  neurasthenic 
or  hypochondriacal  tendency.  A  helpful  psychotherapy  can 
be  of  great  service,  not  only  in  improving  the  humor  of  the 
patient,  which  is  always  a  good  thing  for  him  as  well  as  for 
those  around  him,  but  also  in  favoring  the  cure  of  somatic 
troubles.  The  field  of  psychotherapy  is  thus  very  vast  when 
one  considers  the  man  under  this  double  psychic  and  physical 
aspect,  and  when  one  recognizes  the  impossibility  of  separat- 
ing these  two  elements.  There  are  almost  no  diseased  con- 
ditions in  which  the  morale  remains  unaffected,  and  in  which 
the  physician  can  not  be  of  some  help  by  his  clear,  convinc- 
ing assurances. 


OF  NERVOUS   DISORDERS         209 


CHAPTER   XVII 

The  Therapeutics  of  the  Psychoneuroses — Suppression  of  Actual  Dis- 
orders—  Modification  of  the  Mentality  of  the  Subject  to  Avoid 
Recurrences — Religious  Faith  ;  Suggestions  of  Charlatans ;  Sugges- 
tion by  Medicines ;  Scientific  Suggestion ;  Hypnosis 

IN  the  presence  of  the  various  affections  which  I  have 
defined  as  psychoneuroses,  and  which,  as  much  for  the  conve- 
nience of  language  as  to  include  non-classified  troubles,  I  group 
together  under  the  intentionally  vague  name  of  "  nervousness," 
the  physician  finds  himself  confronted  by  two  obligations : 

(i).  To  dispel  as  quickly  as  possible  the  existing  trouble. 

(2).  To  prevent  the  recurrence  of  the  disorder  in  the 
future. 

It  is  to  the  second  obligation  that  I  attach  the  most  im- 
portance. 

Undoubtedly  one  can  not  separate  the  two  ends  to  be 
pursued,  and  the  thing  of  first  importance  is  to  try  to  de- 
liver the  patient  from  his  present  trouble.  But  physicians  are 
too  often  contented  with  attacking  each  symptom  separately, 
without  striving  to  effect  a  favorable  result  as  a  whole,  by 
bringing  about  a  profound  change  in  the  mentality  of  the 
patient.  Now,  as  this  former  mentality  has  played  a  patho- 
genic role  in  bringing  on  the  symptoms,  the  therapeutic  work 
is  naturally  incomplete.  One  must  look  higher  and  further. 
In  short,  the  cure  of  various  symptoms  of  nervousness  may 
be  brought  about,  often  very  rapidly,  by  the  most  divers  and 
the  most  opposite  measures.  For  when  any  disease  whatso- 
ever yields  to  medications  which  bear  no  relation  to  it,  and 
between  which  there  exists  no  physiological  bond,  it  is  natu- 
ral to  think  of  a  common  factor  which  is  no  other  than  what 
has  been  called  suggestion,  or,  better,  moral  influence. 


210  PSYCHIC   TREATMENT 

This  psychotherapic  action  controls  the  therapeutics  of 
psychoneuroses  to  such  a  degree  that  one  may  make  this 
sweeping  statement: 

The  nervous  patient  is  on  the  path  to  recovery  as  soon  as 
he  has  the  conviction  that  he  is  going  to  be  cured;  he  is  cured 
on  the  day  when  he  believes  himself  to  be  cured. 

This  is  the  idea  that  the  physician  ought  to  get  into  his 
head  if  he  wants  to  cure  his  patient.  But  it  is  not  enough 
for  him  to  accept  this  idea  in  a  skeptical  fashion  and  use  it 
like  a  charlatan;  it  is  necessary  that  he  should  be  convinced 
himself  and  should  know  how  to  hand  on  his  conviction  by  the 
contagion  which  sincerity  engenders.  When  such  a  state  of 
mind  exists  in  the  healer,  it  is  of  slight  importance  what  means 
he  uses;  any  of  them  will  succeed,  provided  it  is  able  to  im- 
plant in  the  mind  of  the  patient  the  fixed  idea  of  speedy 
cure.  Among  these  means  I  count:  religious  faith,  the  sug- 
gestions of  charlatanism,  suggestion  by  the  use  of  medicines 
or  of  physical  means,  scientific  suggestion,  and  psychotherapy, 
properly  so  called,  by  the  education  of  the  reason. 

Religious  faith  would  be  the  best  preventative  against  the 
maladies  of  the  soul  and  the  most  powerful  means  of  curing 
them  if  it  had  sufficient  life  to  create  true  Christian  stoicism 
in  its  followers. 

In  this  state  of  mind,  which  is,  alas!  so  rare  in  the  think- 
ing world,  man  becomes  invulnerable.  Feeling  himself  upheld 
by  his  God,  he  fears  neither  sickness  nor  death.  He  may 
succumb  under  the  attacks  of  physical  disease,  but  morally 
he  remains  unshaken  in  the  midst  of  his  sufferings,  and  is 
inaccessible  to  the  cowardly  emotions  of  nervous  people. 

I  have  seen  Protestant  Christians  accept  the  hardest  life 
and  the  most  distressing  sicknesses,  and  contemplate  with 
serenity  the  certainty  of  their  approaching  death,  without 
seeking  even  to  escape  from  their  inevitable  destiny  by  de- 
manding the  aid  of  medicine ;  they  knew  how  to  suffer  joyfully. 

I  have  experienced  a  deep  sympathy  for  a  poor  Catholic 
missionary  whom  I  advised  not  to  return  to  the  deadly  climate 
of  Africa,  and  who  replied  to  me,  with  an  angelic  smile :  "  I 
will  go  back,  doctor ;  it  is  my  duty,  it  is  my  life ! " 


OF  NERVOUS   DISORDERS          211 

It  was  such  Christianity  as  this  that  made  the  saints  and 
martyrs. 

It  is  said  that  religions  do  not  develop  this  moral  courage. 
Undoubtedly  many  priests  of  every  religion  have  written  ad- 
mirable books  on  "  the  art  of  living,"  and  their  advice  agrees 
fully  with  the  views  which  philosophic  thought  gives  rise  to. 

It  would  be  easy  to  take  advantage  of  worship  and  religious 
faiths,  to  awaken  fervor  and  enthusiasm  in  this  spiritual  life 
in  souls  blinded  by  material  occupation.  But  they  scarcely 
dream  of  it  in  the  high  places  of  the  Church,  and  it  is  to  puerile 
miracles  that  they  have  recourse. 

Among  the  Protestants  they  cure  by  the  laying  on  of  hands 
and  by  their  almost  sacrilegious  prayer,  which  consists  in 
asking  God  to  grant  their  desires.  In  Catholicism  the  touch- 
ing of  certain  relics  is  enough,  and  Lourdes  has  become  the 
place  of  the  most  frequent  pilgrimages. 

Persuaded  that  faith  in  the  cure,  awakened  by  religious 
sentiments,  can  cure  not  only  nervous  troubles,  but  even  or- 
ganic affections,  I  fancied  that  I  would  find  in  the  special 
literature  not  miraculous  deliverances,  but  at  least  extraordi- 
nary cures.  The  reading  of  the  large  volumes  published  on 
this  subject,  that  of  the  Annals  of  Lourdes,  and  a  short 
sojourn  at  the  very  place  of  the  miracle  have  disillusioned  me. 

The  cures  there  are  in  fact  rare ;  many  concern  neuropaths 
who  could  have  been  cured  as  quickly  and  as  well  by  any 
other  suggestive  influence.  Other  patients,  attacked  by  bodily 
lesions,  only  call  themselves  cured  when  they  have  lost  at 
Lourdes  the  nervous  troubles  which  have  accompanied  their 
organic  troubles,  or  when  they  have  seen  an  improvement  in 
their  painful  symptoms,  which,  we  must  not  forget,  are  gener- 
ally psychic  in  their  origin. 

But,  above  all,  I  have  detected  in  the  physicians  of  the 
bureau  of  statistics,  in  spite  of  their  evident  good  faith,  a 
mentality  of  such  a  nature  that  their  observations  lose  all 
value  in  my  eyes.  I  have  not  been  able  to  refrain  from 
remarking  that,  from  the  point  of  view  of  latitude,  Lourdes 
is  not  very  far  from  Tarascon. 

Convinced  from  the  start,  these  physicians  do  not  exhibit 


212  PSYCHIC   TREATMENT 

the  slightest  evidence  of  a  critical  spirit;  their  confidence  in 
the  testimony,  not  only  of  physicians,  but  of  any  person  what- 
soever, passes  all  bounds,  and  I  was  able  to  see  in  their 
narrations  that  many  of  these  so-called  miracles  owed  their 
origin  to  the  absolute  lack  of  established  proof.  A  patient, 
to  whom  they  drew  my  attention  because  the  sores  which  she 
had  on  her  limbs  were  cured  from  one  day  to  another,  told 
me  naively  that,  on  arriving  in  Lourdes,  she  was  plunged  into 
the  pool  without  having  her  dressings  removed,  and  without 
having  shown  her  sores! 

I  left  the  sanctuary  of  Bernadette  with  the  distressing  and 
depressed  feeling  that  superstition  was  still  living  at  the 
dawn  of  the  twentieth  century  as  it  was  in  the  middle  ages. 
I  consoled  myself  by  thinking  that  one  must  never  be  dis- 
couraged when  one  sees  how  slowly  civilization  progresses. 
Truth  is  always  advancing. 

Among  the  charlatans  there  are  some,  I  suppose,  who  are 
sincere.  The  latter  have  many  and  true  successes.  They 
profit,  like  the  places  of  pilgrimage,  by  all  the  mistakes  of 
psysicians;  for  we  are  often  deceived,  and  our  best  masters 
are  not  free  from  their  weaknesses. 

We  often  make  erroneous  diagnoses;  we  too  easily  de- 
clare that  the  disease  is  incurable  when  it  may  be  cured;  we 
have  not  a  sufficiently  clear  idea  of  the  influence  which  the 
mind  exercises  on  the  functioning  of  our  organs.  It  is  thus 
that  we  give  a  fine  opportunity  to  wonder-workers  of  all  kinds. 

The  shameless  charlatans  and  cynics  who  wittingly  deceive 
the  public  have  similar  successes,  altho  they  may  be  more 
ephemeral;  they  also  cure  patients  which  we  have  abandoned. 

Like  the  physicians  of  Lourdes,  the  charlatans  seem  to 
disdain  nervous  affections  and  the  easy  successes  of  sugges- 
tion that  are  within  reach  of  everybody.  They  want  de- 
cided cures  of  organic  diseases,  of  cancer,  tuberculosis,  and 
fractures.  I  know  one  of  them  who  calls  himself  a  specialist 
for  meningitis,  such  scope  do  the  mistakes  of  some  of  our 
greatest  practitioners  give  to  the  healers ! 

A  certain  mental  bond  exists  between  these  irregular  prac- 


OF   NERVOUS    DISORDERS          213 

titioners  of  medicine  and  the  practitioners  who  prescribe 
medicines  or  physical  means  with  a  suggestive  intention. 

There  are  among  physicians  all  shades  of  mentality,  from 
that  which  says,  crudely,  "  The  common  people  want  to  be 
deceived;  therefore,  let  them  be  deceived  "  (Vulgus  vult  decipi, 
ergo  decipiatur),  to  that  which  has  resort  to  a  prescription, 
saying,  "  Let  something  be  done,  or,  at  least,  seem  to  be 
done"  (Ut  aliquid  Hat,  ant  factum  csse  videatur}. 

I  know  very  well  that  there  are  occasions  where  the  most 
veracious  physician  may  have  recourse  to  these  means  and 
give  a  medicine  to  satisfy  the  patient,  but  the  physician  who 
often  resorts  to  this  deception  is  certainly  not  conscientious. 
He  is  negligent ;  he  takes  refuge  in  his  laziness  instead  of  re- 
flecting and  thinking  out  a  rational  plan  of  treatment.  He  is, 
moreover,  an  impatient  fellow  who  does  not  know  what  can 
be  obtained  by  persevering  persuasion. 

It  is  just  that  clients  who  have  discovered  in  what  manner 
they  are  treated  should  take  their  leave  of  such  physicians. 
Quite  recently  I  have  seen  a  patient  lose  all  confidence  in  his 
physician,  a  very  distinguished  man,  because,  in  order  to  break 
his  habit  of  taking  bromide,  he  had  added  some  sodium 
chloride  in  proportion  as  the  dose  was  diminished.  It  was, 
moreover,  a  useless  deception,  for  the  patient  would  have 
given  it  up  if  he  had  advised  him  to  do  so.  Do  not  let  us 
forget  the  orthodox  in  the  profession,  who,  like  the  sincere 
charlatans,  obtain  marvelous  results.  To  the  innocent  let  us 
be  generous!  I  share  on  this  point  the  opinion  of  my  excel- 
lent friend,  M.  Professor  Sahli,  who  said  to  me  one  day :  "  If 
I  were  very  ill,  I  would  rather  be  treated  by  a  homeopath  who 
would  give  me  nothing  than  by  an  allopath  imbued  with  a 
sense  of  his  therapeutic  power." 

On  the  other  hand,  the  physician  exercises  an  excellent 
influence  when  he  intervenes  by  employing  with  discretion  a 
useful  medication,  or  rational  physical  measures;  when  he 
wisely  aids  nature,  and  when  he  enhances  the  value  of  this 
action  by  the  confidence  with  which  he  inspires  the  patient. 

Let  us  now  pass  on  to  scientific  suggestion. 

With  Mesmer  and  his  magnetic  wand  we  find  the  concep- 


214  PSYCHIC   TREATMENT 

tion  of  a  mysterious  force  acting  upon  the  organism.  The 
German  physician,  whose  sincerity  it  is  difficult  to  appreciate 
after  a  hundred  years  have  passed,  succeeded  in  calling  forth 
various  manifestations  of  nervousness  in  the  majority  of  the 
ladies  of  Paris,  and,  what  was  more  to  his  advantage,  he  also 
knew  how  to  cure  them.  He  took  for  his  guidance  and, 
consequently,  for  the  foundation  of  his  suggestive  authority, 
a  very  simple  theory.  Listen  to  an  extract  from  his  aphorisms : 

"  The  perfect  harmony  of  all  our  organs  and  of  their 
functions  constitutes  health.  Sickness  is  only  the  aberration 
of  this  harmony.  The  cure  consists,  then,  in  reestablishing 
the  disturbed  harmony.  The  general  remedy  is  the  application 
of  magnetism." 

It  is  impossible  to  have  a  therapeutic  principle  that  is 
clearer  and  more  concise! 

But  since  then  Deslon,  the  successor  of  Mesmer,  has  dis- 
cerned the  fact  that  the  imagination  alone  produces  all  these 
effects.  He  recognizes  this  without  any  circumlocution  when 
he  says :  "  But  since  the  medicine  of  imagination  cures,  why 
do  we  not  use  it  ?  "  We  shall  find  this  sophism  in  our  modern 
hypnotizers.  In  spite  of  these  clear  statements  of  Deslon 
they  could  not  see  it;  the  magnetizers  continued  their  passes, 
and  the  public  waxed  enthusiastic  over  this  mysterious  agent. 

With  Braid,  one  might  believe  to  have  found  the  cause 
of  hypnotic  phenomena  in  the  sensorial  fatigue  caused  by  the 
fixation  of  a  brilliant  object,  and  in  the  sleepy  influence  pro- 
duced by  the  slight  strokings  of  the  passes.  Hypnosis  seemed 
to  be  an  extraphysiological  condition  due  to  material  influ- 
ences. 

Under  its  scientific  appearance  this  theory  takes  us  into 
the  past,  and,  for  a  long  time,  we  have  seen  less  clearly  than 
Deslon  in  the  eighteenth  century.  The  hypnotic  states  have 
been  studied  as  diseased  manifestations.  Charcot  himself  has 
not  seen  clearly  enough  the  unique  influence  of  the  imagina- 
tion, and  his  studies  have  helped  to  thrust  the  hypnotizable 
subjects  into  the  class  of  hysterics.  With  the  metallotherapy 
of  Burq,  the  medicinal  treatment  from  a  distance  of  Luys, 
we  are  led  astray  once  more,  and  we  return  to  superstition. 


OF  NERVOUS   DISORDERS          215 

The  light  comes  to  us  only  with  the  works  of  Liebault, 
and,  above  all,  of  Bernheim.  While  the  first,  by  his  experi- 
mental success  and  the  simplicity  of  his  measures,  demon- 
strates the  reality  of  the  facts  and  the  ease  with  which  one 
can  obtain  hypnosis,  Bernheim  found  the  key  to  the  phe- 
nomena, and  showed  that,  in  this  domain,  suggestion  is  every- 
thing. 

Among  the  authors  who  have  been  interested  in  this  ques- 
tion, Bernheim  is  the  only  one,  to  my  knowledge,  who  has 
reached  any  logical  conclusion. 

He  has,  as  it  were,  discovered  human  suggestibility,  or, 
rather,  as  one  knows  it  in  many  instances,  he  has  shown  that 
this  credulity,  which  he  calls,  I  do  not  know  why,  credibility, 
is  common  to  all  men,  and  that  those  who  seem  refractory 
are  so  only  for  the  moment  and  by  reason  of  wholly  contingent 
psychological  conditions  in  which  they  find  themselves  when 
confronted  by  the  experimenter. 

After  having  for  a  long  time  put  his  patients  to  sleep,  in 
order  to  make  suggestions  of  cure  to  them,  he  came  to  see 
that  he  could  do  without  this  artificial  sleep,  and  he  practised 
suggestion  in  the  waking  state,  stating  the  cure,  and  making 
the  hope  of  it  glitter  before  the  eyes  of  the  patient.  He  was 
the  first  who  dared  to  say:  There  is  no  hypnosis,  there  is 
nothing  but  suggestion! 

I  reproach  him  with  only  one  thing,  and  that  is,  that 
having  departed  from  hypnosis  and  succeeding  in  bringing 
about  the  hypnotic  state  in  90  per  cent,  of  cases,  he  did  not 
always  dispense  with  "  the  process,"  the  crude  affirmation  of 
wonder  working.  Undoubtedly  he  did  not  neglect  the  wholly 
moral  influence  and  the  paternal  exhortation,  but  this  ortho- 
pedia  is  still  unsatisfying  and  too  rapid.  The  practise  of 
hypnosis  has  accustomed  one  to  immediate  success,  to  theat- 
rical effects.  It  leads  its  patients  by  the  nose,  making  them 
believe  everything  that  it  wants  them  to  believe;  its  thera- 
peutic skepticism  has  no  limits;  everything  is  suggestion. 

I  do  not  find  the  same  logic  among  those  whom  one  would 
call  the  successors  of  Bernheim.  Undoubtedly  the  majority 
have  admitted  the  evident  influence  of  the  -verbal  suggestion, 


216  PSYCHIC   TREATMENT 

so  superabundantly  demonstrated  by  the  school  of  Nancy. 
All  have  been  obliged  to  recognize  that  they  can  not  always 
obtain  the  desired  somnambulistic  condition  which  they  call 
hypnotic  sleep,  and  they  content  themselves  with  suggestion 
in  the  waking  state.  But  what  differences  there  are  in  the 
mental  conditions  of  all  these  practitioners!  Some,  wholly 
preoccupied  with  their  success  at  the  clinic,  hypnotize  or  sug- 
gest with  all  their  might.  They  have  no  theories  and  they 
have  no  interest  but  to  cure.  I  do  not  at  all  doubt  their 
success,  but  I  do  not  envy  them  it. 

Others  have  at  the  same  time  those  qualities  of  "  suggester  " 
which  make  great  healers,  and  a  scientific  spirit  which  makes 
them  analyze  this  action,  but  they  are  "  in  durance  vile." 
Physiological  psychology  has  no  more  secrets  for  them,  since 
they  have  mastered  cerebral  histology,  and  they  see  the  cen- 
tripetal irritations  gain  entrance  to  the  nervous  centers,  carom 
from  cell  to  cell,  and  rebound  in  the  centrifugal  direction. 

They  can- not  see  that,  if  "  suggestion  "  and  "  persuasion  " 
are  identical  in  their  action,  when  one  means  by  that  that  both 
inculcate  ideas,  they  are  at  two  ends  of  the  same  chain,  as 
the  one  is  addressed  to  blind  faith,  while  the  other  appeals  to 
clear,  logical  reason.  One  tendency,  above  all,  persists  in  a 
great  many  observers ;  that  is,  the  tendency  to  see  in  hypnosis, 
and  even  in  suggestion,  abnormal  phenomena  taking  place  by 
way  of  the  nerves,  or  even  by  mental  representations,  without 
participating  in  the  superior  psychism,  the  ego. 

Grasset,  with  a  talent  for  popularizing  things  which  seem 
to  me  dangerous,  has  summed  up  these  views  in  his  book  on 
hypnotism  and  suggestion. 1  This  author  admits  a  certain 
automatism  in  the  psychic  domain,  and  distinguishes  a  superior 
psychism  and  an  inferior  psychism  (or  superior  automatism). 
The  superior  automatic  actions  have,  according  to  him,  dis- 
tinct centers — on  the  one  hand,  superior  psychic  centers,  and, 
©n  the  other,  reflex  centers. 

These  centers  are  neither  in  the  bulbomedullary  axis  (re- 
flexes), nor  even  in  the  basal  ganglia  and  midbrain  (superior 

1  L"  hypnotising  el  la  suggestion.    Par  le  Prof  esseur  Grasset,  de  Montpellier.    Biblio- 
thiqut Internationale  de psychologic  expirimcntale.    Paris,  O.  Doin,  1903. 


OF   NERVOUS   DISORDERS 


217 


reflexes,  inferior  automatism).  They  are  in  the  cerebral  cor- 
tex, but  they  are  distinguished  from  the  centers  of  the  supe- 
rior psychism. 

He  sums  up  these  views  in  the  following  scheme : 
"O  represents  the  center  constituting  the  highest  psychic 
power,  as  it  may  be  understood  of  a  great  number  of  distinct 


/__ — Tr*^-  ^~^\~ — —  > 

^^ 


FIG.    3 


neurons.  It  is  the  center  of  the  personal,  conscious,  free  and 
responsible  ego  (the  italics  are  mine). 

"  Below  is  the  polygon  (A,  V ,  T,  E,  M,  K)  of  the  superior 
automatic  centers.  On  one  side  the  sensory  centers  of  re- 
ception, as  A  (auditory  center)  ;  V  (visual  center)  ;  T  (cen- 
ter for  general  sensation) ;  on  the  other  side,  motor  centers,  as 
K  (kinetric  center),  M  (center  for  articulate  speech),  E  (cen- 
ter for  writing). 

"  These  centers,  all  situated  in  the  gray  substance  of  the 
cerebral  convolutions,  are  connected  by  all  manner  of  trans- 


218  PSYCHIC   TREATMENT 

cortical,  interpolygonal  fibers,  connected  with  the  periphery 
by  subpolygonal  centripetal  paths  (aA,  vV ,  tT)  and  by  the 
centrifugal  paths  (Ee,  Mm,  Kk),  and  connected  with  the  su- 
perior center,  O,  by  superpolygonal  fibers,  some  centripetal 
(ideosensory),  the  others  centrifugal  (ideomotor). 

"  One  may,  or  may  not,  be  conscious  of  automatic  acts, 
according  to  whether  the  automatic  activity  is  or  is  not  com- 
municated to  the  center,  O,  which  is  the  center  of  personal 
consciousness. 

"  The  consciousness  or  unconsciousness  does  not,  then, 
need  to  figure  in  the  essential  characters  of  the  polygon's,  or 
superior  automatic  actions ;  they  only  become  conscious  by  the 
addition  of  the  activity  of  O  to  the  polygon's  own  activity. 

"  But  the  actions  represented  by  the  polygon  are  psychic 
actions,  because  there  is  memory  and  intellectuality  in  their 
functioning. 

"  In  the  normal  and  physiological  state,"  continues  Grasset, 
"  as  a  rule,  all  these  are  in  action  at  the  same  time ;  their  actions 
are  interwoven  and  superimposed." 

He  admits  that  in  certain  physiological  states  there  is  a 
certain  disassociation  between  O  and  the  polygon,  a  mental 
subpolygonal  disassociation.  This  condition  exists  in  dis- 
traction and  sleep. 

This  disassociation  is  still  more  distinct  in  nightmare,  and 
in  the  automatic,  involuntary,  and  unconscious  movements 
which  make  tables  turn  and  move  the  divining-rod  of  seekers 
for  springs  or  treasures,  and  which  direct  mind-readers  (Cum- 
berlandism)  and  the  pencil  of  spirit  mediums. 

In  short,  disassociation  may  be  due  to  pathologic  condi- 
tions, as  in  natural  or  induced  somnambulism,  in  ambulatory 
automatism,  in  catalepsy,  and  hysteria.  And,  entering  into 
the  analysis  of  these  states  of  more  or  less  complete  disasso- 
ciation, he  adds :  "  Nothing  is  mental  but  the  maladies  of 
the  superior  O  psychism.  But  hysteria  is  more  often  a  malady 
of  the  inferior  polygonal  psychism." 

Applying  these  ideas  to  the  analysis  of  the  facts  of  hyp- 
nosis and  of  suggestion,  Grasset  displays  a  disconcerting 
electicism.  On  one  hand,  with  Bernheim,  he  defines  hypnosis 


OF   NERVOUS    DISORDERS          219 

as  a  state  of  suggestibility;  on  the  other  hand,  he  admits,  with 
the  hypnotist,  that  there  is  a  pathologic  condition  of  impres- 
sionability of  the  polygon. 

Hypnosis  exists  for  Grasset;  it  is  diseased  and  extraphy- 
siological ;  it  is  not  the  result  of  simple  credulity,  and  he  says : 
"  Credulity  is  a  normal  condition ;  its  center,  O,  is  weak,  but 
it  functions.  One  is  credulous  in  his  O,  but  he  is  suggestible 
in  his  polygon." 

This  scheme  is  ingenious,  but  that  is  all.  I  would  be  car- 
ried too  far  from  my  subject  if  I  tried  to  analyze  here  this 
work  that  is  crammed  with  ideas,  and  to  answer  the  argu- 
ments, more  specious  than  solid,  of  the  clever  neurologist. 

But  there  is  one  point  which  interests  me  because  it  bears 
directly  upon  my  therapeutic  ideas.  Grasset  admits  the  fact 
of  suggestion.  He  recognizes  that  one  man  can  act  on 
another  by  the  medium  of  verbal  or  written  statements,  whether 
accompanied  or  not  by  such  procedures — as,  a  fixed  gaze,  or 
passes  which  increase  the  suggestibility ;  but  he  adds :  "  Sug- 
gestion is  a  morbid  phenomenon,  or  at  least  an  extraphysio- 
logical  phenomenon,  which  must  be  clearly  distinguished  from 
physiological  influence  in  its  various  degrees,  and  which  is  not 
observed  in  everybody.  The  condition  of  suggestibility  is 
characterized  by  subpolygonal  disassociation,  the  polygonal 
activity,  or  even  the  hyperactivity,  and  the  complete  subjection 
of  the  polygon  to  the  O  center  of  the  hypnotizer ;  it  is  a  poly- 
gon, emancipated  from  its  own  O  center,  obeying  a  foreign 
O  center." 

I  can  not  share  the  views  of  Grasset  on  this  point.  The 
suggestible  condition  is  normal.  One  can  boldly  say  that 
everybody  is  hypnotizable  and  suggestible.  The  subjects  who 
prove  refractory  are  those  who  are  temporarily  in  an  unfavor- 
able psychological  situation:  under  the  sway  of  skepticism, 
fear,  or  distraction.  The  exact  knowledge  of  the  facts  of 
suggestion  render  the  individual  less  suggestible,  and  that  is 
why  physicians  more  often  escape  this  influence;  but  this 
immunity  is  acquired  by  reflection. 

When  observers  such  as  Liebault  and  Bernheim  state  that 
they  have  succeeded  in  at  least  90  per  cent,  of  their  subjects, 


220  PSYCHIC   TREATMENT 

when  Wetterstrand,  Forel,  and  Oscar  Vogt  succeed  in  going 
beyond  97  per  cent.,  it  is  no  longer  permissible  to  set  up 
against  these  figures  the  30  per  cent,  limit  shown  by  the 
school  of  Paris,  or  the  10  per  cent,  of  Seppilli.  In  statis- 
tics of  this  kind  the  highest  figures  measure  the  suggestibility ; 
the  failures  of  other  observers  show  that  they  have  not  had 
the  same  degree  of  suggestive  authority. 

Contrary  to  Grasset,  I  would  then  say :  "  Every  man  is 
suggestible,  even  hypnotizable,  just  as  long  as  he  does  not 
oppose  this  influence  by  another  of  rebellious  mentality.  The 
best  precaution  against  this  psychic  slavery  would  be  imper- 
turbable confidence  in  his  independence,  and  a  calm  reason 
which  detects  the  secret  of  this  weakening  influence. 

Experiments  show  that  about  3  per  cent,  of  men  possess 
this  moral  strength.  It  is  sad,  but  that  is  how  matters  stand. 

I  also  repudiate  the  idea  of  considering  this  suggestibility 
as  a  disease  and  a  disease  of  the  polygon.  As  if  this  latter, 
capable  of  independence  and  of  will,  was  emancipated  from 
the  power  of  O  \  It  is  not  that  the  polygon  asserts  its  inde- 
pendence in  the  face  of  O,  it  is  the  superior  ego  which  relaxes 
the  surveillance  which  it  ought  always  to  exercise. 

As  I  have  already  shown  in  speaking  of  suggestibility,  our 
conscious  thinking  ego  abdicates  his  throne,  sometimes  because 
he  thinks  he  ought  to  allow  his  inferiors  to  act,  with  voluntary 
indifference  or  negligence,  and  sometimes  because  he  is  the 
victim  of  hasty  conclusions — in  short,  when  he  grants  to  others, 
by  the  very  virtue  of  his  irrationalism,  the  power  of  acting 
on  himself. 

Yes,  the  O  of  the  hypnotizer,  of  the  "  suggester,"  of  all 
persons  who  lead  us,  acts,  if  you  will,  on  our  polygon,  but 
always  through  the  medium  of  the  O  of  the  subject  influenced. 
All  heterosuggestion,  in  order  to  become  active,  must  pass  to 
the  state  of  autosuggestion,  and  this  phenomenon  of  conviction 
passes  into  the  superior  psychism. 

That  which  is  here  impressionable  is  not  the  polygon  in- 
capable of  directly  obeying  a  strange  influence;  it  is  the  O, 
it  is  our  intellectual  ego. 

The  hypnotizer  has  no  power  whatsoever  on  us,  or,  rather, 


OF  NERVOUS   DISORDERS         221 

he  has  only  that  which  we  recognize  in  him  by  the  very  virtue 
of  our  own  mental  debility.  He  stands  before  us,  holding 
in  his  hands  a  chain;  it  is  we  who,  in  incredible  blindness 
when  it  is  a  question  of  bad  suggestion,  in  our  pardonable 
desire  for  cure,  when  hypnosis  has  a  praiseworthy  end  in 
view,  fasten  the  other  end  of  the  chain  around  our  necks. 

To  exclude  all  necessary  participation  of  O,  they  have 
argued  concerning  hypnotic  facts  in  animals.  It  is  probable 
that  many  of  these  facts  have  nothing  to  do  with  hypnosis. 
But,  whatever  they  may  be,  one  here  falls  into  the  error  of 
Descarte,  who  only  allowed  a  soul  to  man  and  made  the  animal 
a  machine.  The  majority  of  cases  of  powerlessness  and  cata- 
leptiform  conditions,  which  they  have  succeeded  in  producing 
in  animals,  seem  to  result  from  sentiments  of  fear  and  intimi- 
dation— that  is  to  say,  in  the  sum  of  mental  representations 
which  have  their  seat  in  the  superior  psychism,  in  the  think- 
ing and  feeling  ego. 

Hysteria,  like  other  psychoneuroses,  is  to  my  mind  a  mental 
disease.  It  is  the  superior  ego  which  is  weak,  and  which  thus 
permits  the  "  polygon  "  a  semblance  of  autonomy. 

One  detects  in  all  these  patients  the  it 'rationalism  which 
creates  this  slavery  in  the  presence  of  others.  This  weakness 
can,  it  is  true,  coexist  with  a  certain  intelligence  in  other  do- 
mains. But  an  educated  and  intelligent  man,  who  is  made 
conversant  with  these  ideas,  will  no  longer  allow  himself  to 
be  hypnotized  or  made  to  act  on  suggestion;  he  will  accept 
nothing  but  the  councils  of  reason. 

I  would  undertake  to  immunize  the  majority  of  subjects 
against  all  suggestive  influence  (in  the  restricted  sense  of  the 
word),  and  that  not  by  appealing  to  their  polygon,  in  which 
I  do  not  take  much  stock,  but  to  their  ego  in  the  highest  in- 
dividual sense,  by  making  their  minds  critical,  and  giving  them 
a  conscious  sense  of  their  independence. 

I  can  not  too  strongly  insist  on  this  idea  that  all  "  nervous- 
ness "  denotes  in  the  subject  who  is  afflicted  with  it  a  mental 
defect  or  a  characteristic  lack  of  logic.  Sometimes  this  de- 
fect seems  to  exist  only  in  a  limited  degree,  and  constitutes 
nothing  more  than  a  "  mono-superstition."  More  often  a  later 


222  PSYCHIC  TREATMENT 

psychological  examination,  in  conversation  touching  on  the 
most  varied  subjects,  will  reveal  other  disorders  in  the  mental 
mechanism.  At  a  glance  the  physician  then  sees  that  he  has 
a  mind  to  care  for,  and  that  he  must  modify  and  help  this 
weakness  of  intellect  by  education. 


OF  NERVOUS   DISORDERS         223 


CHAPTER  XVIII 

Rational  Psychotherapy— Its  Efficacy  in  All  Domains  of  Medicine — The 
Necessity  for  Impressing  the  Patient  with  the  Conviction  of  Cure — 
Blind  Faith  and  Rational  Faith  —  The  Persistence_that  is  Necessary 
to  Establish  the  Idea  of  Cure  —  Organic  Complications  —  Contrary 
Suggestions  —  Necessity  of  Changing  the  Mental  State  of  the  Sub- 
ject—  Favorable  Conditions  for  Attaining  this  End 

THE  psychotherapy  which  I  call  rational  has  no  need  of 
this  sort  of  preparatory  narcosis  of  hypnosis,  or  of  this  hyper- 
suggestibility  that  is  itself  suggested.  It  is  not  addressed  to 
an  impressionable  polygon,  but  simply  to  the  mind  and  the 
reason  of  the  subject.  This  psychic  therapy  is  indicated  in 
all  the  affections  in  which  one  recognizes  the  influence  of 
mental  representations  or  ideas,  and  they  are  legion. 

It  is  a  great  mistake  to  believe  that  psychic  therapy  is 
applicable  only  to  psychoneuroses,  that  it  is  an  aid  for  the 
specialist  in  neurology  and  the  alienist  alone,  and  that  the 
practitioner  can  pass  it  by.  Moral  influence  nearly  always 
comes  in,  and  ever  since  medicine  has  existed  patients  and 
physicians  have  been  able  to  prove  it.  It  is  not  unusual  to 
see  the  patient's  condition  improve  immediately  after  the  visit 
of  the  physician,  either  as  a  consequence  of  the  favorable 
assurances  that  he  has  expressed,  or  from  the  sympathy  which 
he  shows  to  his  patient.  This  psychotherapy  has  existed 
through  all  time.  To  know  how  to  apply  it  has  always  been 
the  highest  quality  of  those  practitioners  who  <are  also  phy- 
sicians of  the  soul,  and  who  have  known  how  to  acquire  and) 
keep  a  confiding  and  appreciative  clientele.  They  are,  per- 
haps, more  numerous  in  the  country  and  small  towns  than 
in  great  centers,  where  competition  develops  mercantilism  and 
tends  to  make  the  physician  forget  his  humanitarian  calling. 

Surgery  itself  could  not  be  practised  without  this  moral 
influence.  Without  doubt,  the  diagnosis  and  the  operation 


224  PSYCHIC  TREATMENT 

demand  other  qualities,  but  the  attitude  of  the  surgeon  is  of 
chief  importance  when  it  is  a  question  of  revealing  the  prog- 
nosis and  leading  the  patient  to  accept  operative  intervention. 

By  his  patience,  his  gentle  firmness,  and  the  precision  of 
his  advice  the  surgeon  exerts  a  real  fascination  over  his  clients. 
There  are  some  surgeons  whom  you  would  let  cut  your  head 
off;  there  are  others  whom  you  would  not  trust  with  your 
finger  nails. 

In  organic  diseases  therapeutic  intervention  may  act  ma- 
terially either  on  the  lesion  or  on  the  symptoms.  But  man 
does  not  suffer  as  an  animal.  He  does  not  feel  only  the 
crude,  painful  sensations;  he  exasperates  them  by  his  fears 
and  his  pessimistic  reflections.  Often  what  he  calls  his  soul 
is  more  diseased  than  his  body,  and  sometimes  this  moral 
suffering  which  succeeds  physical  illness  persists,  even  when 
a  real  improvement  has  already  taken  place. 

I  remember  an  old  man  who,  afflicted  with  cholelithiasis 
and  arteriosclerosis,  had  seen  his  condition  improve  tre- 
mendously, and  whom  I  one  day  found  plunged  back  into 
the  deepest  discouragement.  To  my  question,  "  How  goes 
it  to-day  ?  "  he  replied,  sourly,  "  Worse  than  ever.  I  am  weak ; 
I  have  unpleasant  sensations  in  my  skin;  I  am  disheartened, 
and  I  have  pains  everywhere ;  and  you,  you  pretend  that  I  am 
better!" 

I  proceeded  to  make  a  thorough  examination,  and  said 
to  him :  "  My  dear  sir,  you  are  better  than  ever ;  you  are  on 
the  eve  of  complete  recovery,  and  I  will  prove  it  to  you :  you 
had  fever  last  week  (you  measured  and  noted  it  yourself), 
now  you  have  not  had  any  for  four  days;  you  were  as  yellow 
as  an  orange,  you  have  no  longer  any  trace  of  icterus;  your 
urine  was  dark  green  in  color,  it  is  now  straw  color;  your 
tongue  was  coated,  it  is  clean;  your  heart  beat  too  fast  and 
irregularly,  under  the  influence  of  digitalis  it  beats  70;  your 
enlarged  liver  has  gotten  back  to  its  normal  dimensions. 
And  you  want  me  to  tell  you  that  you  are  doing  badly !  No, 
my  dear  sir,  you  are  doing  very  well,  but  the  jaundice  has 
acted  upon  your  morale;  you  see  everything  from  a  dark 
point  of  view,  and  you  think  your  trouble  is  physical  when 


OF  NERVOUS   DISORDERS         225 

it  is  altogether  mental.  You  are  in  low  spirits  to-day.  Chase 
away  all  these  ideas,  and  you  will  see  all  your  discomforts 
disappear.  I  am  not  going  to  give  you  any  medicine,  for 
I  do  not  know  any  in  the  pharmacopoeia  which  will  turn  a 
pessimist  into  an  optimist." 

The  patient  threw  me  a  furious  look,  and  would  not  believe 
me  at  all,  but  the  next  day  he  received  me  with  a  hearty  oath, 
and  said :  "  You  were  just  right  yesterday !  After  you  went 
away  I  examined  myself,  I  looked  at  my  tongue,  at  my  urine, 
and  at  my  temperature  chart;  I  even  counted  my  pulse,  and 
I  saw  that  you  were  in  the  right.  My  spirits  soon  improved ;  I 
breakfasted  in  a  victorious  state  of  mind,  and  soon  I  felt  very 
well!" 

I  often  meet  this  old  man,  and  he  always  smiles  at  me 
in  recalling  this  moral  cure  that  worked  so  rapidly,  altho 
he  was  getting  over  a  cholemia. 

There  are  no  diseases  in  which  the  psychological  physician 
can  not  find  an  opportunity  for  moral  treatment,  whether 
through  dissipating  prejudices,  or  toning  up  his  patient  by  an 
encouraging,  serious,  or  pleasant  word.  To  bring  a  smile 
to  the  face  of  the  patient  is  often  the  best  way  to  dissipate 
these  sorrowful  states  of  mind  that  are  grafted  on  to  the 
bodily  ills.  The  true  physician  does  more  good  by  his  words 
than  by  his  prescriptions. 

But,  if  psychotherapy  is  useful  in  the  treatment  of  all 
diseases,  it  becomes  necessary  when  it  is  a  question  of  those 
wholly  mental  affections  to  which  I  have  devoted  these  chap- 
ters. I  know  that  this  is  not  the  opinion  of  everybody,  and 
that  many  still  persist  in  applying  the  ordinary  methods  of 
treatment  to  these  ills.  I  have  proved  the  inadequacy  of  these 
attempts  at  physical  therapeutics  and  seen  the  efficacy  of 
mental  medicine  too  often  for  me  to  turn  back  now.  I  con- 
sider that  it  is  in  direct  psychotherapy  before  everything  else 
that  we  must  search  for  the  remedy  for  this  nervousness  that 
invades  the  body. 

We  must  not  be  contented  with  such  vague  moral  action 
and  suggestion  as  is  incorporated  in  all  therapeutic  work. 
We  must,  on  the  contrary,  define  precisely  this  influence  of 


226  PSYCHIC  TREATMENT 

the  mind  on  the  body,  analyze  it  psychologically,  and  grasp 
the  mechanism  of  the  physiological  reactions  which  follow 
the  movements  of  the  soul.  Our  faith  in  these  measures 
is  not  sufficiently  lively,  and  many  patients  still  suffer  from 
our  timidity  and  our  therapeutic  indecision.  If  the  nervous 
patient  only  gets  better  when  he  believes  that  he  is  going  to 
get  better,  the  physician  does  not  succeed  in  his  work,  except 
when  he  has  a  confident  expectation  of  the  success  of  his 
treatment. 

In  order  to  reach  this  end  the  physician  must  know  how 
to  get  hold  of  his  patient.  It  is  necessary  from  the  very 
start  that  he  should  establish  between  them  a  strong  bond 
of  confidence  and  sympathy.  Even  at  the  first  interview  this 
relationship  must  be  decided  upon. 

It  may  happen  that  a  patient  will  think  better  of  certain 
hasty  judgments,  and  that  favorable  relations  may  be  estab- 
lished in  consequence;  if  the  physician  has  been  a  little  too 
brusque,  or  has  failed,  by  his  impatience,  to  make  his  entree, 
as  it  were,  he  can  still  correct  this  fault.  But  in  general  the 
first  consultation  gives  the  measure  of  the  degree  of  under- 
standing which  is  going  to  be  established,  and  on  which,  in 
a  great  part,  the  final  success  depends. 

The  patient  should  immediately  feel  that  the  physician  does 
not  regard  him  only  as  a  "  client,"  nor  only  as  an  "  interest- 
ing case,"  but  that  he  is  a  friend  with  no  idea  but  to  cure 
him.  We  practitioners  ought  to  show  our  patients  such  a 
lively  and  all-enveloping  sympathy  that  it  would  be  really 
very  ungracious  of  them  not  to  get  well. 

When  the  patient  experiences  this  state  of  mind  in  the 
physician  he  is  already  well  advanced  on  the  way  to  cure. 
He  is  like  one  under  a  spell  of  a  kindly  thought,  and  this 
moving  joy  gives  him  at  once  the  feeling  of  euphoria.  The 
physician  experiences  the  counter  effect  of  this  emotion,  and 
can  also  say  to  himself :  "  That  is  all  right ;  my  patient  will 
get  well ! " 

A  physician's  power  to  act  depends  on  the  depth  of  his 
conviction.  But  however  deep  it  may  be  it  must  be  sin- 
cere; it  must  be  established  on  the  diagnosis  and  the  prog- 


OF  NERVOUS    DISORDERS          227 

nosis.  It  is  this  view  of  the  future  which  is  going  to  bring 
hope  to  the  patient,  and  give  him  the  feeling  of  certainty. 

The  charlatan  does  not  hesitate  in  his  statements;  not  he! 
he  presents  himself  as  a  healer,  and  failure  does  not  baffle 
him.  The  believers  who  cure  by  religious  influence  can  al- 
ways beat  a  safe  retreat  by  saying :  "  You  did  not  have  faith." 
Many  hypnotizers  come  to  take  a  like  attitude,  and  the  feeling 
of  holding  a  panacea  in  their  hands  often  makes  them  negli- 
gent upon  the  matter  of  diagnosis.  We  will  try,  they  say, 
to  dissipate  these  troubles  by  suggestion,  and  then  we  shall 
see  if  the  disease  is  a  nervous  one. 

The  physician  who  does  not  want  to  have  recourse  to  any 
but  rational  means  does  not  resort  to  these  measures.  His 
prognosis  can  be  based  only  on  an  examination  made  accord- 
ing to  all  the  rules  of  the  clinician.  He  ought,  from  the 
start,  to  make  the  differential  diagnosis  between  organic  af- 
fections and  the  psychoneuroses  which  simulate  them  so  well. 

Some  of  my  confreres  have  objected  that  this  means  of 
giving  to  the  patient  the  conviction  of  cure  is  nothing  but 
suggestion  pure  and  simple.  Yes,  if  by  suggestion  one  un- 
derstands all  proceedings  which  consist  in  putting  an  idea 
into  the  head;  no,  if  one  takes  into  account  the  rational  char- 
acter of  the  means  employed.  There  is  faith  in  all  convic- 
tion, but  there  is  blind  faith  and  reasoning  faith.  There  is  a 
great  difference  of  mentality  between  the  man  who  is  content 
with  a  statement,  who  allows  himself  to  be  under  the  influence 
of  the  personality  of  the  healer,  and  the  man  who  acquires 
confidence  by  the  clear  exposition  of  the  reasons  to  believe. 

As  a  rule,  the  physician  who  knows  at  the  same  time  both 
the  psychopathic  conditions  and  the  organic  affections  can 
very  quickly  judge  of  the  situation,  and  can  establish,  on  a 
rational  basis  and  on  his  own  experience,  the  prognosis  which 
is  going  to  give  the  patient  the  expectancy  of  cure. 

Sometimes,  however,  questions  of  differential  diagnosis  are 
intricate,  and  it  is  necessary  to  make  observations  for  several 
weeks  before  the  physician  dares  to  pronounce  the  magic 
words,  "  You  will  get  well !  "  This  is  a  difficult  position  for 
the  conscientious  physician,  and  I  should  not  be  at  all  sur- 


228  PSYCHIC   TREATMENT 

prised  if  a  patient  whom  I  could  not  succeed  in  curing  found 
cure  in  the  hands  of  an  irregular  practitioner  of  medicine  who 
was  more  bold  in  his  statements. 

When  one  has  succeeded  in  inspiring  the  patient  with  a 
quasi  certitude  of  cure,  it  is  necessary  to  encourage  this  state 
of  mind  during  the  whole  treatment.  Every  time  that  there 
is  any  fact  detected  which  confirms  the  favorable  prognosis 
it  should  be  commented  on,  and  continually  brought  up  in 
the  conversation.  All  improvement,  however  slight  it  may 
be,  even  when  it  does  not  concern  the  particularly  distressing 
symptoms,  should  be  noted,  and  the  patient  must  draw  new 
reasons  for  raising  his  courage  from  these  proofs.  Nothing 
is  insignificant  in  this  domain;  one  must  leave  no  stone  un- 
turned. 

There  are  some  patients  who  reach  this  desired  state  of 
mind  at  the  start.  I  have  seen  some  who  were  confronted 
with  this  dilemma:  "  Perhaps  the  doctor  will  send  me  away, 
then  I  am  lost ; "  or,  "  He  will  undertake  my  treatment,  then 
I  am  saved !  " 

Others  reach  conviction  but  slowly.  They  are  skeptical, 
sometimes  even  argue  acrimoniously,  and  often  plead  against 
their  own  case.  It  seems  as  tho  they  take  a  malicious  pleas- 
ure in  proving  that  they  are  incurable.  Others  manage  only 
to  get  a  vague  hope,  or  a  lukewarm  faith,  that  would  by  no 
means  remove  mountains;  they  are  passively  obedient,  follow 
all  the  prescriptions  of  the  treatment,  but  they  have  no  enthu- 
siasm. Sometimes  the  conversion  takes  place  very  late,  at 
the  end  of  the  cure,  and  here  success  depends  only  on  patience 
and  the  imperturbable  perseverance  which  the  physician  de- 
votes to  obtaining  the  result. 

The  following  example  is  typical:  A  few  years  ago  I 
had  under  my  treatment  a  young  girl  twenty  years  of  age,  who, 
in  consequence  of  overwork,  had  fallen  into  a  nervous  con- 
dition that  was  difficult  to  classify.  Calm,  reasonable,  and  in 
no  wise  hysterical,  from  the  mental  point  of  view,  she  had 
suffered  for  eight  years  from  headaches  and  intense  pain  in 
the  back,  hindering  all  her  work.  In  addition,  the  patient  had 
had,  according  to  her  parents,  two  epileptic  attacks  with  such 


OF  NERVOUS   DISORDERS          229 

complete  loss  of  consciousness  that  she  had  retained  no  memory 
of  these  symptoms. 

The  examination  of  the  cutaneous  sensibility  revealed  no 
stigmata  of  hysteria.  The  patient  limped  slightly,  dragging 
her  left  foot  in  consequence  of  a  slight  paresis  of  the  muscles, 
which  put  the  foot  in  dorsal  reflexion.  Finally,  the  patient 
presented  equally  on  both  sides  an  evident  epileptoid  tremor 
and  a  marked  exaggeration  of  the  knee  jerks. 

The  patient,  who  was  emaciated  and  tired,  was  put  under 
a  treatment  of  regular  rest,  isolation,  overfeeding,  and  psycho- 
therapy. She  took  it  with  the  greatest  docility,  gained  twenty- 
eight  pounds  in  weight,  and  regulated  her  disturbed  digestive 
functions,  but  the  painful  phenomena  were  not  relieved,  and 
at  the  end  of  two  months  I  found  her  in  utter  despair.  "  I 
want  to  go  away,"  she  said,  bursting  into  tears.  "  You  know 
that  I  have  been  obedient,  and  that  I  have  not  neglected  any 
of  your  prescriptions;  they  have  produced  some  effect  upon 
my  state  of  nutrition,  but  I  always  have  pains  in  my  head 
and  back."  "  I  understand  your  discouragement,"  I  replied, 
"  but  I  do  not  share  it,  and  I  will  tell  you  why :  you  have,  it 
is  true,  the  same  pains,  but  I  see  that  you  have  made  some 
progress.  Not  only  have  you  grown  stronger  but  you  have 
lost  that  trembling  of  the  feet  that  you  had  on  your  arrival." 

With  a  bitter  smile  the  patient  objected :  "  What  conse- 
quence is  this  trembling?  I  never  suffered  from  it;  it  was 
you  who  discovered  it  by  suddenly  lifting  up  my  foot!  I 
came  for  my  headaches  and  my  backaches;  there  is  not  the 
slightest  sign  of  improvement  in  that  line." 

"  I  agree  perfectly  with  you,  and  I  do  not  blame  you  at 
all  for  discouragement  that  is  so  caused;  but  as  a  physician 
I  look  at  the  situation  in  another  way.  Your  nervous  trouble 
is  composed  of  different  symptoms;  the  headache  and  the 
backache  are  those  which  are  most  distressing  to  you,  they 
are  the  only  ones  to  which  you  will  grant  the  slightest  im- 
portance, and  you  have  a  right  to  do  so.  For  me,  speaking 
medically,  all  these  symptoms  have  their  value.  To  you  the 
trembling  of  the  feet  means  nothing,  to  me  it  is  as  important 
as  the  headaches ;  it  also  is  one  of  the  symptoms  of  your  dis- 


230  PSYCHIC  TREATMENT 

ease.  These  are,  I  might  say,  spots  of  the  same  ink,  and  if 
we  have  succeeded  in  effacing  the  smallest  there  are  chances 
that  we  shall  succeed  in  making  them  all  disappear.  Stay; 
take  courage !  " 

She  stayed  a  month  more,  and  went  back  cured. 

I  hold  that  the  physician  who  wants  to  be  right  in  serious 
nervous  cases  ought  very  carefully  to  preserve  this  funda- 
mental idea:  that  there  are  no  symptoms  without  importance, 
and  that  the  slightest  improvement  ought  to  lend  encour- 
agement to  his  confidence.  He  is  like  a  sailor  who  foresees 
a  favorable  change  in  the  weather  on  noticing  a  slight  bright- 
ening which  the  passengers  do  not  see,  or  to  which  they  would 
not  think  of  attaching  any  importance. 

There  is  another  clinical  rule  which  the  psychotherapeutist 
should  never  forget;  that  is,  that  he  must  not — at  least,  unless 
it  is  absolutely  necessary — admit  the  presence  of  two  concomi- 
tant affections  in  his  patient.  If  you  have  recognized  any 
form  whatsoever  of  nervousness,  put  into  this  list  all  the 
symptoms  which  you  observe.  Naturally  it  is  not  necessary 
to  force  things;  one  may  be  perhaps  hysterical  and  tubercu- 
lous, neurasthenic  and  rheumatic;  one  may  have  several  dis- 
eases at  the  same  time.  But  it  is  not  necessary  to  admit  this 
situation  except  on  manifest  proofs.  All  organic  complica- 
tions, especially  if  they  are  more  serious  than  the  nervousness, 
darken  the  prognosis.  Therefore,  to  reassure  the  patient,  and 
to  give  him  the  conviction  that  he  will  be  cured,  there  must 
be  a  frank  prognosis.  The  physician  ought  to  be  able  with 
a  genial  smile  to  kindle  this  faith.  Any  restrictions  will  make 
it  lukewarm. 

Alas!  we  are  sometimes  forced  to  it  with  the  tabetics, 
for  example,  in  whom  a  melancholy  neurasthenic  state  often 
becomes  grafted  upon  the  spinal  cord  affection.  In  certain 
cases  an  exaggeration  of  the  tendon  reflexes,  however  slightly 
it  seems  to  predominate  on  one  side,  comes  to  unsettle  our  con- 
victions; we  suspect  a  process  of  spinal  sclerosis,  and  we  no 
longer  dare  to  adopt  that  affirmative  tone  that  is  so  necessary 
in  order  to  attain  the  end.  We  hesitate  to  the  detriment  of 
our  moral  action  when  we  find  the  symptoms  of  a  pseudo- 


OF  NERVOUS   DISORDERS          231 

angina  of  the  chest  in  a  subject  of  a  certain  age  or  in  one 
who  is  syphilitic,  or  when  we  detect  an  intermittent  pulse  or 
an  increased  second  sound  of  the  heart. 

It  is  well  not  to  allow  one's  self  to  be  troubled  by  the  pres- 
ence of  clinical  symptoms,  the  exact  value  of  which  is  not  suffi- 
ciently established.  Twice  in  the  course  of  this  year  I  have 
just  escaped  losing  my  moral  influence  by  having  given  too 
much  importance  to  Babinski's  sign.  I  had  detected  in  my 
patients,  and  that  on  one  side  only,  a  dorsal  flexion  of  the 
big  toe,  on  tickling  the  sole  of  the  foot,  when  the  other  side 
reacted  normally.  Fortunately  I  saw  the  danger  that  there 
would  be  in  using  this  fact  in  the  prognosis.  In  the  presence 
of  my  patients  I  hid  this  doubt,  resting  on  the  general  ensemble 
of  the  symptoms.  I  persisted  in  predicting  a  cure,  and  I  had 
the  happiness  of  obtaining  it. 

Without  resorting  to  artifice  or  without  telling  lies  the 
physician,  by  keeping  this  intention  of  truth  in  his  mind,  must 
inculcate  in  the  patient  this  conviction — that  he  is  going  to  be 
cured.  He  must  have  the  gift  of  persuasion ;  he  must  be  like 
an  advocate  who  is  convinced  of  the  merits  of  his  case;  he 
must  know  how  to  present  his  arguments  and  multiply  them, 
and  fairly  hammer  into  the  patient's  head  the  idea  that  he 
will  get  well. 

When,  having  come  to  a  definite  diagnosis,  I  tell  the  patient 
that  his  trouble  is  nervous,  I  immediately  add,  "  and  mind 
you,  in  my  dictionary  the  word  nervous  is  always  coupled 
with  the  word  curable;  these  two  adjectives  always  go  to- 
gether." And  when,  still  distrustful,  he  adds :  "  Yes,  doctor, 
but  you  speak  in  a  general,  abstract  manner,"  I  reply  to  him, 
with  a  parry  for  every  thrust,  "  No,  I  speak  concretely.  You 
are  a  nervous  subject,  and  you  will  be  cured! "  Ah,  in  these 
moments  of  indecision  the  physician  must  not  have  an  irreso- 
lute mind  and  content  himself  with  skeptical  phrases  and  timid 
statements!  It  is  the  time  to  be  eloquent  while  always  re- 
maining sincere,  like  an  advocate  in  the  court  of  assizes  who 
is  profoundly  convinced  of  the  innocence  of  his  client  and 
wants  to  snatch  him  from  condemnation. 

This  it  not  what  many  physicians  do.     If  there  are  some 


232  PSYCHIC   TREATMENT 

who  are  charlatans,  there  are  still  others  who  are  clumsy  and 
who  practise  suggestion  on  its  reverse  side.  To  a  neuras- 
thenic they  state  that  he  will  be  cured,  yes,  but  add  that  this 
disease  lasts  about  three  years!  How  consoling  that  is  for 
a  patient  who  has  to  gain  his  living ! 

I  have  seen  a  physician  seriously  trying  to  console  a  lady 
who  was  afflicted  with  nervous  troubles  by  assuring  her  that 
she  would  be  better  at  the  menopause.  She  was  thirty-two 
years  old! 

Many  patients  owe  the  persistency  of  their  functional 
troubles  to  the  physician  who,  by  imprudent  words,  has  given 
them  a  fixed  idea. 

Many  nervous  people  who  suffer  with  their  stomachs  be- 
lieve that  there  is  some  disease  of  that  organ,  and  it  is  the 
physician  who  by  his  useless  examinations  has  led  them  into 
error.  Hysterical  paralyses  would  be  cured  more  quickly  if 
they  were  not  treated,  like  true  paralyses,  by  local  measures. 
The  various  psychoneuroses,  which  they  call  traumatic,  would 
not  be  so  serious  if  the  physician  knew  that  it  was  a  question 
of  psychic  trouble,  if  the  hypochondriacal  condition  was  not 
encouraged  by  the  physical  treatments  and  the  constant  idea 
of  indemnity. 

I  have  seen  a  girl  fourteen  years  old,  who,  at  ten  years  of 
age,  had  received  from  a  baby  a  blow  with  a  drumstick  on 
the  left  shoulder.  There  had  been  a  sharp  pain  in  conse- 
quence, but  there  was  no  lesion  at  all.  The  cure  would  have 
taken  place  in  a  few  hours  if  the  physician  had  known  how 
to  calm  the  little  girl.  But  he  stated  before  the  patient: 
"  This  is  serious,  very  serious !  It  is  traumatic  neuritis.  I 
would  much  rather  that  the  patient  had  broken  both  her 
arms ! "  The  nervous  pains  lasted  four  years ;  the  pain  ex- 
tended to  the  back  and  to  the  right  arm,  without  any  sensory 
or  motor  paralysis  or  atrophy  occurring  to  confirm  the  ex- 
istence of  neuritis.  Here  is  a  disease  created  out  of  whole 
cloth  by  the  physician.  It  is  an  inverse  suggestion  producing 
an  opposite  effect. 

Sometimes  a  physician  recognizes  the  psychic  nature  of 
the  trouble,  but,  being  too  impatient,  he  states  it  in  terms 


OF   NERVOUS   DISORDERS          233 

which  hurt  the  patient.  The  latter  concludes  from  it  that  he 
is  taken  for  a  tender  creature  who  can  not  bear  a  pain,  for 
an  imaginary  invalid.  This  is  a  fear  which  we  must  never 
allow  to  take  root  in  the  mind  of  the  patient.  It  is  necessary 
to  believe  in  the  reality  of  his  pains  and  to  show  him  full 
sympathy,  and  if,  little  by  little,  we  can  prove  to  him  that 
they  have  a  psychic  origin,  it  must  be  done  in  a  long,  friendly 
conversation.  Then  the  patient  sees  clearly.  I  have  heard 
country  people  say  to  me :  "I  see  that  you  speak  truly,  and 
that  it  is  not  through  negligence  that  you  do  not  give  me 
any  medicine.  It  would  have  been  more  simple  for  you  to 
write  me  a  prescription,  instead  of  giving  me  an  hour  to 
explain  my  trouble  so  clearly  to  me.  I  understand  what  you 
tell  me,  and  I  have  the  feeling  that  I  know  how  to  follow 
your  advice." 

It  is  necessary,  then,  with  nervous  patients  to  know  how 
to  get  hold  of  the  patient  at  the  start,  and  inculcate  in  him  the 
fixed  idea  that  he  will  get  well.  It  is  also  necessary  to  main- 
tain the  fixity  of  this  idea  until  the  cure,  to  lead  his  conviction 
by  reasons  that  are  always  more  cogent.  In  short,  in  the* 
course  of  treatment,  one  must  study  the  mentality  of  the 
subject,  detect  his  lack  of  logic,  his  exaggerated  suscepti- 
bility, and,  in  the  daily  conversations,  modify  his  natural  men- 
tality; for  it  is  to  this  mentality  that  one  must  look  for  the 
first  cause  of  the  trouble. 

This  aspiration  to  change  the  mentality  of  a  subject  in  a 
few  weeks'  time  makes  one's  confreres  smile.  I  am  not  as- 
tonished at  it,  and  I  should  have  smiled  with  them  twenty 
years  ago ;  I  should  have  said :  "  That  is  impossible ;  chase 
away  what  is  natural,  and  it  will  come  back  at  a  gallop !  " 

Well,  no;  it  is  easier  than  one  would  think  to  change  the 
mental  state  of  a  patient,  to  inculcate  in  him  healthy  maxims 
of  medical  philosophy ;  and  if  the  natural  state  of  affairs  comes 
back  it  is  by  no  means  at  a  gallop,  and  it  is  easy  to  chase  it 
away  again.  It  is  evident  that,  in  order  to  obey  these  indi- 
cations successfully  and  bring  about  the  cure,  one  must  have 
time — the  physician  and  the  patient  must  hold  personal  rela- 
tions for  a  sufficient  length  of  time. 


234  PSYCHIC   TREATMENT 

We  shall  see  that  sometimes  the  psychotherapic  work  may 
be  rapid  enough  not  to  require  more  than  one  or  two  conver- 
sations. But  in  the  majority  of  cases  the  trouble  is  of  too 
long  standing  to  yield  in  so  short  a  ti.ne.  In  serious  and  ob- 
stinate cases  a  prolonged  treatment  is  required  in  a  clinic 
where  one  can  add  physical  treatment  to  continued  moral 
influence. 

I  have  adopted  for  this  end  the  treatment  of  Weir  Mitch- 
ell, who,  as  every  one  knows,  recommends  rest  in  bed,  iso- 
lation, and  overfeeding,  and  various  other  less  important 
measures. 

Without  being  indispensable,  these  conditions  are  particu- 
larly favorable  to  the  psychic  treatment ;  and  I  do  not  hesitate 
to  advise  physicians  who  want  to  cultivate  rational  psycho- 
therapy to  have  recourse  to  this  method.  Little  by  little  they 
will  see  that  it  is  not  always  applicable,  that  one  must  know 
how  to  individualize,  to  take  circumstances  into  account,  and, 
when  they  have  acquired  the  gift  of  persuasion,  they  will  dare 
to  attempt  more  rapid  cures  at  a  hotel  or  in  any  boarding- 
house  whatever,  even  in  the  midst  of  the  family.  But  to 
attain  that,  one  must  have  acquired  experience  under  favor- 
able conditions,  and  I  see  no  more  propitious  way  than  that 
which  belongs  to  the  treatment  outlined  by  the  Philadelphia 
physician. 


OF  NERVOUS   DISORDERS         235 


CHAPTER   XIX 

Weir  Mitchell's  Treatment;  Modifications  which  Ought  to  be  Made  in 
It  in  Order  to  be  Efficacious  —  Utility  of  the  Measures  of  Rest  in 
Bed — Overfeeding  and  Isolation — Importance  of  the  Psychic  Factor 
— The  Treatment  of  Psychoneuroses  Ought  to  be  a  Cure  of  Psy- 
chotherapy Made  Under  the  Favorable  Conditions  of  Rest,  Over- 
feeding, and  Isolation  —  Sketch  of  this  Mora!  Influence 

IT  is  more  than  twenty  years  since  I  adopted  Weir  Mitch- 
ell's treatment,  and  at  the  start  I  practised  it  in  the  spirit  of 
the  author — that  is  to  say,  by  attributing  the  chief  importance 
to  physical  measures.  I  then  held  to  absolute  rest  in  bed 
and  complete  isolation,  without  letters  and  without  visits;  I 
sought  to  obtain  as  rapidly  as  possible,  by  overfeeding,  great 
increases  in  bodily  weight.  Like  the  American  and  the  Eng- 
lish physicians,  I  attached  some  importance  to  massage,  and 
at  last,  conversant  with  questions  of  medical  electricity,  I 
conscientiously  practised  general  faradization. 

Little  by  little  this  treatment  has  been  modified  in  my 
hands.  I  very  quickly  abandoned  the  electricity.  I  found 
the  monotonous  occupation  of  running  an  electrode  over  a 
patient's  body  was  very  much  of  a  bore ;  sometimes  I  stopped 
a  little  while  in  this  work  to  converse  with  him,  and  soon  I 
perceived  that  a  kindly  word  and  a  little  philosophic  counsel 
was  more  precious  than  half  an  hour's  faradization. 

Later,  in  many  of  the  cases,  I  gave  up  what  was  often  a 
distressing  measure — absolute  isolation.  When  my  patients 
had  not,  at  the  end  of  a  week,  made  sufficient  gain  in  weight, 
I  was  not  disturbed  by  it.  I  did  not  send  away  the  masseuse, 
who  was  not  responsible  for  it,  but  I  contented  myself  by 
advising  my  patients  to  eat  a  little  more.  After  a  while  I 
came  to  even  dispense  with  rest  in  bed,  when  the  condition  of 
nutrition  did  not  seem  to  me  sufficiently  bad  to  require  this 


236  PSYCHIC  TREATMENT 

measure.  At  last,  and  above  all,  I  attributed  more  and  more 
value  to  moral  influence. 

I  retained  for  serious  cases  physical  measures  of  treat- 
ment, but  my  treatment  had  other  ends  in  view.  It  was  no 
longer  a  "  rest  cure,"  as  the  Americans  and  the  English  call 
it.  It  was  no  longer  a  "  Mastkur,"  a  fattening  process  ac- 
cording to  the  Germans,  who  seem  to  me  to  attach  too  much 
importance  to  embonpoint.  In  France,  in  spite  of  all  the 
efforts  of  Professor  Dejerine  at  La  Salpetriere,  they  apply 
these  methods  so  little  that  they  speak  of  it  as  the  "  isolation 
cure." 

The  treatment,  such  as  I  conceive  it,  after  having  practised 
it  for  a  long  time,  is  a  treatment  of  psychotherapy,  made  under 
the  favorable  conditions  of  rest,  isolation,  and  overfeeding. 

I  have  said  that  these  measures  are  not  always  necessary, 
but  that  they  are  invaluable  aids  in  serious  cases. 

Let  us  analyze  the  action  of  these  physical  measures. 
Rest  in  bed  is  clearly  indicated  in  all  cases  where  feelings  of 
fatigue  and  symptoms  of  denutrition  are  prominent.  In  those 
exhausted  persons  who  are  on  the  threshold  of  physiological 
bankruptcy  there  is  an  evident  interest  in  reducing  expenses 
to  the  minimum,  and  it  is  usually  easy  to  make  the  patient 
understand  the  necessity  of  this  economy.  Nevertheless, 
many  protest  against  this  measure.  They  share,  with  the 
public  and  with  many  physicians,  the  opinion  that  it  is  weak- 
ening to  stay  in  bed.  I  have  no  trouble  in  making  them  see 
that  they  are  mistaken.  What  weakens  patients  who  are 
confined  to  bed  is  not  the  bed,  but  the  sickness  which  obliges 
them  to  stay  there.  It  is  that  which,  through  fever,  or  loss 
of  appetite,  or  insomnia,  or  pain,  or  intoxication,  brings  on 
emaciation  and  amyasthenia.  When  these  troubles  do  not 
exist,  staying  in  bed  strengthens  the  organism. 

Naturally,  it  is  not  necessary  to  keep  muscular  strength 
in  view,  especially  that  of  the  inactive  lower  extremities.  One 
must  not  go  to  bed  and  expect  to  become  athletic.  This  lost 
muscular  force  returns,  however,  very  quickly  with  exercise, 
and  I  have  seen  patients  who  have  spent  six  or  eight  weeks 
in  bed  show  considerable  activity  after  two  or  three  days. 


OF  NERVOUS   DISORDERS         237 

For  all  the  other  organs  a  prolonged  sojourn  in  bed,  usually 
for  six  weeks,  has  incontestable  advantages.  The  patients 
often  long  for  this  rest,  and  once  there,  they  very  quickly 
lose  the  sense  of  chronic  lassitude. 

Contrary  to  current  ideas,  the  appetite  in  such  patients 
grows  better  in  bed,  the  digestion  is  better;  and  if  this  rest 
at  first  favors  constipation,  overfeeding  soon  overcomes  this 
inconvenience.  Lying  on  the  back  acts  very  favorably  on  the 
circulation,  cerebral  irrigation  is  favored  by  the  horizontal 
position,  and  those  patients  with  a  cadaverous  complexion  and 
drawn  faces  soon  begin  to  look  much  better  in  bed.  This 
beneficent  action  of  prolonged  rest  on  the  organs  of  the  cir- 
culation has  not  been  sufficiently  comprehended.  I  have 
proved  it  in  a  striking  manner  in  various  cases  of  organic 
cardiopathy.  Two  of  my  patients,  one  of  them  afflicted  with 
mitral  insufficiency,  the  other  with  arteriosclerosis,  in  whom 
comparative  rest,  a  milk  diet,  and  digitalis  had  only  led  to 
slight  results,  recovered  a  normal  pulse  after  a  hemiplegia 
had  condemned  them  to  absolute  rest.  The  pulse  diminished 
little  by  little,  and  stayed  regular  for  a  year  in  the  case  of  one 
of  the  patients ;  the  other,  a  right  hemiplegic,  for  almost  three 
years  has  had  no  return  during  all  this  long  period  of  cardiac 
trouble  and  the  phenomena  of  angina  pectoris  which  heralds 
the  approach  of  the  end. 

We  must  not  forget  that  in  bed  patients  who  are  so  sen- 
sitive to  all  influences  are  protected  against  inclemency  of  the 
weather,  and  very  often  against  microbic  infections,  which  are 
apt  to  result  from  contact  one  with  another. 

The  principal  objection  is  generally  the  fear  of  ennui.  The 
patients  are  frightened  at  the  idea  of  staying  so  long  without 
reading  and  without  amusement.  I  sometimes  allow  my  pa- 
tients to  do  some  little  manual  work,  such  as  needlework,  or 
a  game  of  patience,  or  solitaire ;  I  permit  them  to  turn  over  the 
pages  of  some  illustrated  magazine,  but  I  have  always  be- 
lieved it  best  to  forbid  reading — at  least,  for  the  patients  who 
complain  of  a  tired  feeling  in  the  head. 

It  is  very  easy  to  persuade  patients  if  one  will  take  the 
trouble  to  show  them  the  reason  for  these  measures  of  com- 


238  PSYCHIC   TREATMENT 

plete  rest.  It  is  the  physician's  privilege  to  bring  them  to  a 
docile  frame  of  mind,  not  by  orders  but  by  counsels. 

When  the  patient  has  fully  grasped  the  necessity  of  di- 
minishing expenses,  it  is  not  difficult  to  show  him  of  what 
advantage  it  would  be  to  increase  the  receipts;  but  then  new 
objections  arise.  The  patient  is  usually  a  nervous  dyspeptic 
who  believes  himself  afflicted  with  dilatation  of  the  stomach, 
or  enteroptosis,  and  who  will  reply  to  you,  "  But  I  can  not 
eat !  "  Now,  this  patient,  who  is  often  emaciated  to  the  last 
degree,  has  need  of  good  food,  of  overfeeding,  even,  as  much 
to  gain  weight  rapidly  as  to  dissipate  the  fixed  idea  of  dys- 
pepsia. This  is  the  point  where  one  must  know  how  to 
achieve  a  decisive  victory  from  the  start. 

If  you  are  sure  of  your  diagnosis  of  neurasthenia,  do  not 
hesitate  to  declare  to  your  patients  that  a  bountiful  and  varied 
diet  is  necessary  if  they  wish  to  get  out  of  their  state  of 
chronic  debility.  Show  them  quite  clearly  all  the  detrimental 
consequences  of  the  restricted  regime  which  they  have  fol- 
lowed up  to  that  time,  and  often  for  many  years :  progressive 
malnutrition,  growing  weakness,  constipation  and  its  attendant 
evils.  Go  even  a  little  further  and  show  them  the  necessity 
for  overfeeding  during  the  greater  part  of  the  treatment  if 
their  emaciation  demands  it.  Why  overfeeding?  Because 
normal  feeding,  in  spite  of  rest,  is  not,  as  a  rule,  sufficient  to 
bring  about  a  rapid  increase  of  bodily  weight;  because  this 
increase  is  desirable  as  much  to  produce  a  real  euphoria  as 
to  act  morally  on  the  patient;  because  the  patient  who  will 
have  undergone  this  regime  (they  all  stand  it)  will  be  forever 
after  rid  of  his  hypochondriacal  fears. 

It  is  of  the  greatest  importance  to  obtain  these  victories 
at  the  start ;  they  often  decide  the  fate  of  the  whole  campaign. 

When  the  patient  has  no  great  dyspeptic  troubles,  or  when, 
altho  complaining  of  the  stomach,  he  follows  some  absurd 
regime,  such  as  eating  meat  or  eggs  in  excess,  one  can  put 
him  immediately  upon  a  diet  of  three  meals  a  day  and  give 
him  milk  three  times  a  day  between  meals;  he  will  very  soon 
see  that  he  gains  by  the  change. 

But  more  often  the  dyspepsia  is  of  long  standing,  the 


OF  NERVOUS   DISORDERS         239 

predispositions  are  deep-rooted;  one  would  run  the  risk  of 
compromising  the  result  by  putting  the  digestive  faculties 
to  too  strong  a  test.  Thus  I  have  made  it  a  practise  of  put- 
ting the  patient  upon  a  preparatory  milk  diet.  Experience 
has  shown  me  that  it  is  useless  to  prolong  it  beyond  three 
days,  and  that  after  that  one  can  lead  the  patient  up  to  over- 
feeding. I  will  give  these  measures  of  regime  more  in  detail 
when  I  speak  of  nervous  dyspepsia. 

If  the  majority  of  patients  accept  without  any  great  diffi- 
culty these  two  measures  of  rest  and  overfeeding,  which  lead 
to  the  same  end — that  is,  strengthening  the  patient — they  pro- 
test, however,  most  emphatically  against  isolation.  Yet  this 
isolation  is  very  often  necessary.  It  is  often  imposed  by  the 
very  conditions  of  the  treatment  on  patients  from  other  places 
who  are  taken  care  of  in  the  sanitarium ;  they  can  not  be  in  the 
midst  of  the  family.  But  if  they  could  it  would  not  be 
wise  to  allow  it. 

The  nervous  patient  ought  in  general  to  leave  the  family 
circle  where  he  is  subjected  to  hurtful  influences.  Serious 
lack  of  sympathy  between  the  husband  and  wife,  or  between 
parents  and  their  children,  often  plays  an  etiological  role  in 
the  development  of  psychoneuroses ;  there  are  incompatibilities 
of  temper,  and  the  patients  themselves  recognize  the  necessity 
for  a  separation.  Even  suppose  the  relations  with  the  relatives 
and  friends  to  be  agreeable,  they  are  none  the  less  harmful 
to  these  impressionable  people.  The  letters  which  they  re- 
ceive awaken  homesickness  and  bring  tears  to  their  eyes,  and 
these  emotional  conditions  are  enough  to  bring  on  headaches, 
insomnia,  and  anorexia. 

Convinced  of  the  necessity  for  such  isolation,  I  used  it  in 
every  case  at  the  beginning  of  my  career,  and  it  was  I  who, 
by  weekly  letter,  kept  up  between  my  patients  and  their  friends 
the  necessary  relations.  In  time  I  became  less  severe.  One 
may,  in  many  cases,  if  there  be  no  intellectual  fatigue,  permit 
correspondence  and  visits.  But  when  the  physician  believes 
that  he  can  give  up  any  part  of  the  usual  plan  of  treatment 
he  should  do  it  wittingly,  and  not  allow  himself  to  be  cajoled 
into  concessions.  I  do  not  mean  by  this  that  the  physician 


240  PSYCHIC  TREATMENT 

ought  to  be  jealously  careful  to  indicate  his  authority,  to  make 
the  patient  do  just  as  he  wants  him  to  do.  This  brutal  method 
of  winning  obedience  is  never  wise,  and  it  is  unnecessary  when 
the  physician  knows  how  to  gain  the  confidence  of  his 
patients. 

What  the  patients  fear  most  in  such  isolation  is  to  be  left 
alone  with  themselves,  the  prey  of  their  own  sad  thoughts. 
And  from  the  first  interview  we  find  ourselves  obliged  to 
preach  to  our  patient  a  high  grade  of  stoicism  by  recommend- 
ing optimism  to  him.  It  is  necessary  from  the  start  that  he 
should  know  how  to  make  a  choice  among  this  crowd  of 
thoughts  which  besiege  his  mind  in  these  hours  of  solitude, 
and  that  he  should  repulse  all  feelings  of  discouragement. 
His  optimism  ought  to  be  incited  by  the  idea  of  an  assured 
cure  in  the  near  future.  He  ought,  in  remembering  the  long 
duration  of  his  sufferings  and  the  shortness  of  the  treatment 
(about  two  months),  to  be  able  to  take  the  latter  joyfully, 
and  find  it  short  and  easy. 

It  is  here  that  the  physician  ought  to  possess  the  gift  of 
persuasion,  making  light  of  the  obstacles  which  the  patients 
raise. 

I  remember  a  poor,  uneducated  woman,  who  had  to  un- 
dergo this  treatment  for  a  nervous  condition  of  long  standing 
with  symptoms  of  astasia-abasia,  which  had  always  been  attrib- 
uted to  a  myelopathy.  She  established  herself  with  consider- 
able courage,  said  farewell  to  her  husband  and  her  children 
with  a  bravery  which  astonished  me.  But  at  the  end  of  a 
few  days  her  courage  weakened,  and  I  found  my  patient  in 
tears,  declaring  that  she  was  so  wretched  that  she  could  not 
go  on.  I  told  her  what  a  pity  it  would  be  if  she  gave  up  a  treat- 
ment that  was  so  necessary.  "  Oh,  yes,"  she  said,  "  and  that 
is  just  what  makes  me  so  miserable.  I  know  that  this  treat- 
ment is  the  best  thing  for  me,  and  I  am  so  grieved  not  to  be 
able  to  bear  it.  Will  you  let  me  read  ?  " 

"  I  would  like  to  let  you,"  I  replied,  "  but  I  do  not  think 
that  such  a  concession  would  hasten  matters.  If  you  read  an 
hour  a  day  and  it  is  too  much  for  your  head,  there  will  still 
remain  to  you  about  fifteen  hours  of  daylight  in  which  you 


OF  NERVOUS   DISORDERS         241 

have  time  to  brood  over  your  troubles.  Believe  me,  there  is 
only  one  way  of  chasing  away  your  ennui,  but  it  is  radical. 
It  consists  in  having  the  end  to  be  obtained  clearly  in  sight. 
Think  of  it!  You  have  suffered  for  years  and  your  life  is 
burdensome  to  you.  Your  husband  is  in  despair  to  see  you 
thus ;  and  your  children  do  not  have  the  mother's  care  which 
is  so  necessary  for  them.  Now  the  nature  of  your  trouble 
makes  me  hope  for  a  lasting  cure  by  a  treatment  of  two 
months.  Just  see  how  great  the  end  is  and  how  little  the 
effort.  Keep  this  cure  always  before  you,  stretch  your  arms 
out  toward  it,  enjoy  it  in  advance,  and  the  days  will  seem 
short  to  you." 

The  patient  succeeded  day  by  day  in  creating  in  herself 
this  state  of  mind,  and  at  the  end  of  six  weeks  she  was 
completely  well. 

It  is  very  seldom  that  one  meets  patients  who  are  unable 
to  bear  isolation.  Such  are  either  melancholies,  whom  this 
seclusion  tortures,  or  the  unbalanced,  who  completely  lack 
control  over  themselves.  One  must  have  judgment  to  know 
when  to  renounce  these  measures  and  to  undertake  the  treat- 
ment along  different  lines. 

Judging  from  an  experience  which  has  already  been  long, 
I  do  not  hesitate  to  make  the  statement  that  it  is  generally 
easy  to  bring  patients  to  accept  with  good  grace  these  three 
measures  of  rest,  overfeeding,  and  isolation. 

I  have  continued  to  recommend  general  massage,  consist- 
ing of  a  gentle  rubbing  of  the  large  muscular  masses  of  the 
extremities.  It  stimulates  the  intramuscular  circulation  and 
thus  does  away  with  the  only  inconvenience  of  rest  in  bed.  It 
is  a  passive  gymnastics  without  expenditure  of  nervous  energy 
for  the  patient.  When  practised  by  an  experienced  hand, 
such  massage  leaves  the  patient  in  a  state  of  slight  but  health- 
ful lassitude;  he  feels  warmed,  and  often  experiences  a  desire 
to  sleep ;  massage  of  the  abdomen  may  help  to  reestablish  the 
intestinal  functions.  Moreover,  this  hour  of  physical  treat- 
ment mitigates  to  some  degree  the  isolation.  The  day  passes 
more  quickly  and  the  conversation  of  the  masseur  or  masseuse 
diverts  the  patients. 


242  PSYCHIC   TREATMENT 

It  is  well  if  these  helpers  can  be  sufficiently  intelligent  to 
serve  in  some  measure  as  society  for  the  patients.  Often  by 
their  simple  good  sense,  without  their  having  learned  the 
lesson,  they  seize  the  psychotherapic  indications  and  help  the 
patient  in  his  work.  The  lay  nurses  as  well  as  the  sisters 
know  how  to  exert  this  beneficent  influence;  the  majority  of 
them  possess  the  necessary  tact.  I  ought  to  say,  however, 
that  I  do  not  try  to  develop  this  influence;  it  requires  too 
much  skill  and  sensibility  to  act  upon  sick  minds.  I  might 
add,  that  by  always  working  by  gentle  persuasion  and  never 
by  authority,  I  have  no  need  of  energetic  guards  who  force 
the  patients  to  be  obedient.  I  never  reveal  to  these  helpers 
the  mental  conditions  of  my  subjects;  the  sisters  are  never 
present  at  the  conversation,  and  I  ask  no  more  of  them  than 
a  kindly  solicitude  for  those  confided  to  their  care. 

For  many  years  I  have  abandoned  hydrotherapy  and  elec- 
tricity. They  seem  to  me  absolutely  useless. 

I  have  confined  myself,  in  short,  to  these  three  measures 
— rest,  overfeeding,  and  isolation.  They  may  suffice  in  them- 
selves in  certain  cases  by  their  material  action  and  by  the 
suggestion  to  which  they  give  rise.  Success  may  be  obtained 
by  these  simple  measures,  and  there  are  establishments  where 
they  confine  themselves  exclusively  to  them. 

I  have  already  said  that  in  my  eyes  they  are  simple  auxili- 
aries, and  that  I  place  the  accent  on  moral  treatment,  which 
is  so  easy  to  practise  under  these  conditions.  In  the  daily 
personal  conversations  the  physician  ought  not  to  choose 
in  advance  the  text  of  what  might  be  called  his  sermon.  He 
should  sit  down  beside  his  patient,  and  listen  to  his  plaints 
with  the  greatest  patience 

Above  all,  he  should  never  be  hurried — or,  at  least,  never 
appear  to  be.  The  physician  who  comes  in  like  a  gust  of 
wind,  looks  at  his  watch,  and  speaks  of  his  many  engage- 
ments, is  not  cut  out  to  practise  this  psychotherapy.  It  is 
necessary,  on  the  contrary,  that  the  patient  should  have  the 
impression  that  he  is  the  only  person  in  whom  the  physician 
is  interested,  so  that  he  may  feel  encouraged  to  give  him  all 
his  confidences  in  peace. 


OF  NERVOUS    DISORDERS          243 

Let  your  patient  talk;  do  not  interrupt  him,  even  when  he 
becomes  prolix  and  diffuse.  It  is  to  your  interest  as  well  as 
to  his  to  study  his  psychology  and  to  lay  bare  his  mental  de- 
fects. Help  him,  however,  to  get  on  the  right  road,  and  to 
give  correct  expression  to  his  thoughts.  Catch  his  confessions 
on  the  wing,  as  it  were,  to  point  out  to  him  his  errors  and 
prepossessions,  in  order  to  make  him  put  his  finger  on  his 
mental  peculiarities,  and  to  make  him  understand  the  role  that 
they  have  played  in  the  genesis  or  the  development  of  his 
trouble.  Question  him  about  his  childhood,  and  he  will 
tell  you  episodes  which  show  his  natural  impressionability  and 
his  exaggerated  emotions.  Start  the  patient  upon  the  scent 
which  you  have  picked  up,  and  make  him  admit  that  he  was 
"  a  nervous  subject "  long  before  the  actual  attack. 

Show  him  clearly  by  means  of  examples  to  corroborate 
them  the  dangers  of  this  unhealthy  sensibility.  Note  with  him 
his  indecision  of  character  and  his  pessimistic  tendencies,  call 
his  attention,  with  kindly  tact,  to  his  susceptibility  and  insta- 
bility of  temperament  which  leads  to  bad  temper,  and  his  ten- 
dencies to  selfishness.  Give  him,  on  all  these  subjects,  short 
lessons  on  rational  morality. 

It  is  a  serious  mistake  to  believe  that  only  educated,  cul- 
tivated people  are  accessible  to  these  instructions.  Simple 
good  sense  is  enough,  and  fortunately  it  is  by  no  means  the 
exclusive  property  of  the  privileged  classes.  The  peasant  and 
the  workman  often  have  remarkably  open  minds  for  this 
philosophy.  I  will  even  say  that,  having  a  more  simple  type 
of  mind  and  being  less  distorted  by  prejudices,  they  submit 
more  easily  to  moral  influence.  It  is  not  that  they  are  men- 
tally weak  and  accept  suggestions  more  passively;  no,  they 
understand  shrewdly  enough,  and  their  replies  and  their  un- 
thinking comparisons  clearly  express  their  right  thought. 

A  workman  whose  neurasthenic  wife  has  still  some  vacil- 
lation in  her  mental  state  and  whom  I  encouraged  to  perse- 
vere in  the  struggle,  cried :  "  Yes,  doctor,  I  understand  what 
you  mean ;  we  must  tighten  up  the  screws !  " 

A  poor  girl,  subject  to  obsessions  and  scruples  and  attacks 
of  melancholy,  regained  her  tranquility  each  time  by  means 


244  PSYCHIC  TREATMENT 

of  a  conversation,  and,  going  out  of  my  office,  said  to  a  friend : 
"  There,  I  can  take  a  long  breath  again !  " 

Question  your  patients  on  their  conceptions  of  life  and 
their  philosophy,  for  everybody  has  one,  however  fragmentary 
it  may  be.  Criticize  kindly  the  false  views  and  approve  those 
which  seem  to  you  logical  and  helpful.  Make  an  effort  also 
to  discover  in  your  patient  moral  qualities  and  superiorities, 
and  endeavor  with  all  frankness  to  find  some  merit  in  him 
which  will  raise  him  in  his  own  eyes;  he  has  so  much  need 
of  recovering  confidence  in  himself. 

There  is  some  good  in  all  subjects;  one  you  can  compli- 
ment because  he  is  intelligent,  and  another  because  he  has 
good  sense;  you  will  show  another  that  he  is  a  man  of  heart 
and  of  noble  sentiments. 

One  may  also  even  make  use  of  religious  sentiments  to 
bring  the  patients  back  to  a  moral  standard.  It  may  seem 
strange  to  see  a  freethinker  practising  with  believers,  using 
religious  convictions  and  recommending  them  to  certain  of 
his  patients.  Well,  no;  there  is  no  contradiction  in  that.  I 
have  often  been  able  to  feel  myself  in  a  spirit  of  communion 
with  Christians,  Protestant  pastors,  abbes,  and  the  cloistered 
clergy. 

Undoubtedly  we  are  at  the  antipodes  from  the  point  of 
view  of  our  conceptions  on  questions  of  dogma.  We  are 
even  implacable  adversaries,  for  there  is  war  to  the  death 
between  the  principle  of  authority  and  of  free  inquiry.  But 
the  moment  that  one  leaves  dogmatic  ground  and  reaches 
the  moral  ground  the  accord  is  so  complete  that  we  can  go 
hand  in  hand  to  the  end  of  the  way. 

The  sincere  believers  (and  would  that  there  were  more 
of  them!)  walk  through  life  fixing  their  eyes  on  one  star 
which  is  their  faith;  the  freethinker  bends  his  gaze  upon 
three  stars,  situated  at  the  same  point  of  the  firmament, 
the  True,  the  Beautiful,  and  the  Good.  What  wonder,  then, 
that  they  should  journey  together? 

I  have  always  had  a  horror  of  wicked,  railing  free  thought, 
which,  falling  into  the  same  error  as  its  adversaries,  pretends 
to  solve  the  problems  of  the  Unknowable. 


OF   NERVOUS    DISORDERS          245 

Science  progresses,  she  discovers  little  by  little  the  laws 
which  rule  the  universe,  but  she  knows  nothing  of  their  first 
causes,  or  of  the  force  which  directs  everything.  She  studies 
nothing  but  the  microcosm  in  which  we  live,  and  she  has  no 
right  to  express  herself  in  cutting  statements  concerning  what 
lies  beyond  the  field  of  her  little  lens.  Tolerance  is  the  natural 
fruit  of  well  understood  deterministic  conception. 

The  study  of  the  mental  peculiarities  of  the  patient  ought 
to  be  made  at  the  beginning  of  the  treatment,  for  the  object 
is  to  right  his  judgment  and  correct  his  mentality.  It  is  not 
enough  to  hold  a  few  fortuitous  conversations  with  patients 
curious  about  psychological  problems,  but  one  must  continue 
to  put  forth  an  educative  effort  during  the  whole  treatment. 
One  must,  therefore,  lose  no  time  in  learning  to  know  the 
personality  of  a  patient  and  the  conditions  in  which  he  lives. 

Without  being  indiscreet,  you  ought  to  inform  yourself 
concerning  the  environment  in  which  he  passes  his  life,  and 
the  circumstances  which  have  given  birth  to  his  nervous 
condition.  Sometimes  you  will  find  yourself  in  the  presence 
of  tragic  events,  of  situations  which  it  is  impossible  to  change. 
There  is  nothing  left  for  you  to  do  but  to  soothe  the  patient's 
suffering,  and  you  will  often  be  astonished  at  the  good  that 
you  can  do  by  this  sympathy. 

More  often  still  you  will  find  only  cares  of  a  less  serious 
nature,  and  incompatibilities  of  temper.  You  must  then  teach 
the  patient  the  spirit  of  forbearance,  and  you  can  also,  by  a 
few  words  or  by  letters,  act  on  the  relatives  in  such  a  way 
as  to  put  oil  on  the  wheels  and  bring  about  a  healthy  family 
environment  for  the  patient  to  go  back  to. 

There  are  cases  where  one  succeeds  but  slowly  in  freeing 
the  patients  from  their  mental  defects,  the  suppression  of 
which  is  necessary  for  their  cure.  The  following  example 
is  interesting  in  this  connection: 

An  officer  forty-one  years  of  age  consulted  me  for  a  neur- 
asthenic condition  which  had  slowly  grown  worse  for  fourteen 
years.  He  felt  tired,  and  had  rheumatic  pains  in  the  back  and 
legs.  He  had  headaches,  with  a  sensation  of  gimlets  boring 
into  his  temples.  He  did  not  sleep,  and  wakened  in  the 


246  PSYCHIC   TREATMENT 

middle  of  the  night,  a  prey  to  an  indefinable  terror,  with 
palpitation  of  the  heart  and  profuse  perspiration.  The  sen- 
sations of  fatigue  were  very  pronounced.  I  considered  it 
wise  to  put  him  upon  a  treatment  of  complete  rest  and  isola- 
tion without  insisting  on  feeding,  as  he  had  some  tendency 
to  obesity. 

Improvement  took  place  slowly,  and  at  the  end  of  about 
seven  weeks  the  patient  could  call  himself  cured.  Our  con- 
versations bore  upon  the  most  varied  subjects.  Nevertheless, 
one  day  I  inquired  about  his  sleep.  "  That  is  improving," 
said  the  patient  to  me,  "  constantly  improving,  but  I  still 
have,  toward  one  o'clock  in  the  morning,  a  most  distressing 
feeling  of  anguish  which  lasts  about  half  an  hour."  I  reas- 
sured him  by  showing  him  the  great  progress  which  he  had 
made,  as  these  attacks  of  anguish  had  formerly  lasted  six  or 
seven  hours;  I  made  him  hope  that  they  would  diminish  still 
more,  and  I  added :  "If  you  wake  up  in  the  night  in  such 
distress,  get  up  and  walk  about  on  the  cold  floor  and  drink 
a  glass  of  water,  and  go  back  to  bed." 

The  next  day  he  spoke  to  me  of  one  thing  and  another, 
and  it  was  only  when  I  asked  him  that  he  said  to  me :  "  I 
slept  very  well;  I  took  my  glass  of  water  and  I  fell  asleep 
like  a  child."  I  made  the  reflection  that  my  man  was  not  an 
optimist,  because  he  had  not  hastened  to  announce  his  success, 
but  I  said  nothing  to  him  of  the  observation. 

A  few  days  later  I  inquired  about  the  regularity  of  his 
intestinal  functions,  and,  learning  that  he  was  still  constipated, 
I  gave  him  my  advice  in  writing,  thinking  that  he  would  not 
follow  it  until  after  his  departure  from  the  sanitarium. 

Before  the  patient  left  I  thought  I  ought  to  ask  how  his 
constipation  was.  I  learned  that  the  training  measures  which 
I  had  recommended  had  immediately  succeeded. 

Struck  by  this  tendency  not  to  tell  of  the  success  which 
came  to  him,  I  turned  on  my  patient,  saying  to  him :  "  Major, 
you  are  a  queer  chap !  Twice  I  have  given  you  advice  which 
in  the  twinkling  of  an  eye  has  relieved  you  of  two  symptoms, 
your  nocturnal  distress  and  your  constipation,  of  which  you 
still  complained  bitterly.  You  do  not  even  think  to  tell  me 


OF  NERVOUS   DISORDERS         247 

that  they  are  better,  and  if  I  had  not  asked  you  we  should 
have  gone  on  speaking  of  the  rain  or  of  the  weather !  " 

My  officer  became  thoughtful,  and  said  to  me :  "  Doctor, 
you  have  just  put  your  finger  on  a  fault  which  I  did  not 
know  myself,  and,  now  that  you  draw  my  attention  to  it,  I 
see  that  I  have  had  it  all  my  life,  from  my  earliest  childhood. 
I  have  always  been  so:  I  always  look  on  the  dark  side  of 
things,  and  I  never  discover  the  rose  color." 

"  My  dear  sir,  this  moral  Daltonism  is  very  harmful,  and 
I  consider,  from  the  point  of  view  of  your  cure,  that  the 
conversation  to-day  is  more  important  than  the  entire  treat- 
ment. You  are  in  a  dependent  position:  you  have  superiors 
who  are  not  always  well  disposed,  and  inferiors  who  do  not 
always  do  their  duty.  With  your  tendency  to  look  at  every- 
thing in  a  pessimistic  light  you  can  make  yourself  sick  every 
night.  Trust  me,  change  all  that  for  me!  You  are  going 
back  to  your  service.  Well,  every  evening  sum  up  your  day. 
First  put  into  the  left  scale  of  the  balance  all  the  things  that 
have  troubled  you;  don't  get  worried.  But,  that  being  done, 
turn  to  the  scale  on  the  right,  and  conscientiously  put  into  it 
everything  that  has  been  favorable  to  you,  and  I  believe  that 
the  beam  will  tip  more  often  to  this  side." 

A  few  months  after  this  my  ex-patient  sent  me  an  instan- 
taneous photograph  of  himself,  which  showed  him  on  horse- 
back leaping  over  a  high  barrier.  He  had  written  these 
words  on  it :  "  As  well  in  the  moral  saddle  as  in  the  physical !  " 
And  in  his  letter  he  said  to  me :  "  I  have  succeeded  admirably 
in  making  the  scales  tip  in  my  favor.  Ah!  often  the  scale 
of  annoyances  is  pretty  full,  but  when  I  remember  your  advice 
I  count  up  the  successes  which  seemed  to  me  so  few,  I  heap 
up  the  scale  on  the  right,  and,  as  you  said,  it  i&  that  which 
carries  the  day.  After  that  I  go  to  sleep,  and  in  the  morning 
I  wake  up  in  good  health." 

I  have  often  seen  this  patient  since  in  society;  he  has 
held  his  own  without  any  difficulty.  I  have  known  of  his 
going  through  periods  of  misfortune  which  would  have  been 
enough  to  dismay  a  man  who  had  never  been  neurasthenic. 

Six  years  after  the  treatment  I  met  my  officer  again.     He 


248  PSYCHIC   TREATMENT 

declared  to  me  that  he  was  always  well.  Knowing  that  in  the 
body  of  officers  of  which  he  was  a  part  things  did  not  always 
go  according  to  his  wish,  I  asked  him  if  the  circumstances 
had  become  more  favorable.  "  Oh,  not  the  least  in  the  world ; 
there  are  always  the  same  rivalries  and  the  same  lack  of 
justice.  The  men  are  wolves,  and  that  will  never  change! 
But  it  is  I  who  have  changed  completely.  I  have  my  motto: 
*  Do  your  duty,  come  what  may ! '  I  am  not  disturbed  by  all 
that.  I  live  happily  in  the  feeling  of  duty  accomplished,  and 
in  that  optimism  which  you  have  inculcated  in  me.  Thus  I 
bear  a  charmed  life,  and,  you  see,  it  has  not  hurt  my  advance- 
ment, for  you  behold  me  Lieutenant-Colonel !  " 

And  he  added :  "  If  I  had  not  been  brought  to  think 
about  the  necessity  of  this  moral  attitude,  I  should  have  suc- 
cumbed to  my  failing," 


OF   NERVOUS   DISORDERS          249 


CHAPTER   XX 

Various  Symptoms  of  Nervousness — Digestive  Troubles :  Their  Frequency 
— Mental  Anorexia:  Disgusts,  Sensation  of  Restriction,  and  Depres- 
sion— Stimulation  of  Appetite  by  Psychic  Means — Gastric  Dyspepsia: 
Its  Genesis  and  Its  Aggravation  by  Autosuggestion — Gastric  Trou- 
bles in  the  Insanities  ;  Cerebral  Affections  —  Broussais  ;  Barras  — 
Easy  Diagnosis  of  Nervous  Dyspepsia 

THE  symptoms  of  the  nervousness  are  so  numerous  and  so 
varied  that  one  never  finds  two  cases  just  alike.  Many  pa- 
tients have,  along  with  physical  lassitude  and  moral  weakness, 
the  characteristic  trio  of  functional  disturbances — that  is  to 
say,  dyspepsia,  constipation,  and  insomnia. 

But,  on  the  other  hand,  some  complain  only  of  the  stom- 
ach, and  sleep  well;  others  digest  well,  and  pass  sleepless 
nights.  There  are  nervous  people  subject  to  diarrhea;  there 
are  some  who  have  an  insatiable  appetite,  whereas  the  majority 
lack  appetite.  So  far,  there  is  the  greatest  diversity  in  this 
domain  of  functional  disturbances.  But  it  is  still  worse  when, 
as  one  ought  to  do,  one  examines  the  mentality  of  the  pa- 
tient. One  never  finds  two  identical  characters,  and  it  is  pre- 
cisely these  mental  peculiarities  which  not  only  determine  the 
form  of  the  psychoneurosis,  but  which  give  rise  to  it.  I 
can  not  too  often  repeat  it:  in  all  these  psychopathies  we  must 
seek  for  the  root  of  the  evil  in  the  previous  mentality. 

In  the  presence  of  maladies  so  varied  in  their  manifesta- 
tions it  is  impossible  to  settle  upon  a  plan  of  treatment  appli- 
cable to  all.  One  must  know  how  to  individualize.  Still 
more  than  in  internal  medicine,  we  must  remember  that  we 
are  not  nursing  sicknesses  but  sick  people. 

Altho  I  have  not  yet  succeeded  in  establishing  a  line  of 
conduct  for  all  manifestations  of  nervousness,  nevertheless  I 
hold  that  it  is  possible  to  examine  the  various  symptoms  in 


250  PSYCHIC  TREATMENT 

the  light  of  this  primordial  conception:  nervousness  is,  above 
all,  a  psychic  disorder. 

I  will,  therefore,  review  the  various  functional  disturb- 
ances which  one  observes,  and  I  will  indicate  the  psychothera- 
pic  measures  which  appear  to  me  to  be  useful.  Later  I  will  take 
up  the  mental  troubles  themselves,  and  the  duty  which  de- 
volves upon  us  of  modifying  the  mentality  of  the  subject  and 
of  instructing  him  in  moral  hygiene. 

In  conclusion,  I  will  sum  up  these  ideas  in  a  few  typical 
examples,  and  will  show  the  power  of  psychotherapy  in  serious 
and  long-established  cases  of  the  psychoneuroses. 

I  will  commence  with  the  most  frequent  functional  disturb- 
ances— those  of  the  digestive  apparatus. 

It  is  positively  rare  to  observe  cases  of  the  psychoneuroses 
without  digestive  troubles.  They  vary  infinitely  as  to  inten- 
sity and  symptomatology.  Sometimes  they  are  so  localized 
and  so  apparent  in  the  presence  of  the  mental  symptoms  that 
they  put  one  on  the  wrong  scent,  and  the  practitioner  does  not 
hesitate  to  treat  by  local  measures  the  disease  of  the  stomach 
or  of  the  intestines.  At  other  times  the  subject  appears  so 
evidently  distracted  and  unbalanced  that  the  mental  malady 
is  prominent,  and  the  very  beginner,  or  the  practitioner  of  the 
least  experience,  would  recognize  at  the  start  neurasthenia, 
hysteria,  hypochondriacal,  or  melancholic  conditions. 

But  between  the  two  extremes,  evident  psychopathies  and 
functional  disturbances  so  closely  simulating  organic  affections 
as  to  be  mistaken  for  them,  there  are  a  great  many  interme- 
diaries, and  it  is  here  that  the  judgment  and  the  individual 
mentality  of  the  physician  comes  in. 

If  he  has  been  educated  as  a  surgeon,  if  he  is  an  expert 
in  a  specialty  which  demands  a  certain  manual  dexterity,  or 
if  he  is  a  chemist,  he  will  show  an  exaggerated  respect  for 
precision;  he  will  want  to  find  lesions  and  disturbances  of 
organic  chemistry.  In  order  to  sharpen  his  perception  of 
things  he  specializes  too  much  and  is  led  astray,  and  thus  it 
happens  that  many  physicians,  though  very  clever  and  con- 
scientious, will  diagnose  uterine  affection,  dilatation  of  the 
stomach,  or  organoptosis,  and  if,  along  with  the  disease  which 


OF   NERVOUS    DISORDERS          251 

they  have  studied,  they  note  symptoms  of  nervousness,  they 
are  tempted  to  consider  them  as  secondary. 

If  the  physician  is  something  of  a  psychologist,  if  he  has 
been  able  to  see  that  man  lives  chiefly  by  his  head,  he  will 
consider  the  higher  things.  He  does  not  neglect  the  local 
symptoms,  and  if  in  his  diagnosis  he  narrows  his  vision  on 
occasion,  he  knows  how  to  use  a  "  low  power  "  magnification 
and  to  look  over  the  entire  field.  He  no  longer  has  before  him 
a  uterus  or  a  stomach  like  a  simple  retort;  he  no  longer  ad- 
mits an  affection  of  the  solar  plexus  and  of  cardiac  ganglions ; 
he  no  longer  attributes  the  so-called  nervousness  to  nerves  that 
can  not  help  themselves.  He  recognizes  that  these  poor  nerves 
on  which  we  throw  all  the  blame  of  the  trouble  are  but  very 
passive  conductors.  Undoubtedly  they  can  suffer  from  the 
effects  of  a  traumatism  which  interrupts  their  continuity ; 
they  can  be  attacked  by  inflammatory  processes,  undergo  de- 
generation, or  be  affected  by  toxic  influences ;  but  these  nerves 
have  no  autonomy,  and  one  must  not  look  for  the  cause  of 
nervousness  in  them. 

The  physician  who  reflects  looks  upon  man  as  a  whole,  not 
only  from  the  point  of  view  of  his  animal  functions,  but  from 
the  psychological  point  of  view;  he  considers  not  only  what 
he  eats  or  drinks,  but  he  is  interested  in  what  he  thinks.  And 
little  by  little  he  proves  the  predominance  of  psychic  influences. 
He  perceives  more  and  more  that  he  must  work  upon  the 
morale,  and  successes  show  him  the  justice  of  his  views. 

Anorexia  is  one  of  the  most  frequent  symptoms,  and  some- 
times it  seems  as  tho  it  were  the  only  functional  trouble  ex- 
perienced by  the  patient.  It  is  more  than  thirty  years  since 
Lasegue  showed  the  mental  nature  of  this  loss  of  appetite. 

In  a  great  many  cases  it  is  difficult  to  reveal  the  psycho- 
pathic nature  of  this  trouble.  It  seems  as  tho  it  ought  to 
be  caused  by  dyspepsia,  or  by  pain,  or  by  the  condition  of 
the  tongue.  But  there  is  no  difference  between  these  cases 
as  far  as  the  gastric  symptoms  are  concerned  and  those  in 
which  the  tongue  is  not  even  coated,  or  where  there  is  little 
or  no  trouble  with  the  digestion. 

I  often  see  young  girls  emaciated  to  the  last  degree  who 


252  PSYCHIC   TREATMENT 

have  not  eaten  for  several  months,  and  who  do  not  even  dream 
of  pretending  to  have  a  gastric  malady  to  explain  the  cause 
of  their  conduct.  They  have  no  need  of  eating  or  drinking, 
that  is  all.  Neither  is  it  the  fixed  idea  of  slow  suicide  by 
inanition  which  prompts  them. 

They  do  not  know  why  they  do  not  eat;  as  a  rule  they 
do  not  even  think  that  they  are  sick.  All  feminine  coquetry 
has  disappeared  in  them,  and  they  admit,  without  being  in 
any  degree  impressed  by  it,  their  paleness  and  the  fact  that 
they  have  wasted  away  to  skeletons. 

These  are  insane  without  any  doubt.  In  the  majority  of 
cases  this  condition  becomes  established  in  consequence  of 
emotions,  such  as  disappointed  ambitions,  the  loss  of  a  friend, 
or  family  annoyances. 

It  is  often  easy  to  bring  these  patients  back  to  normal  ali- 
mentation and  to  restore  them  to  a  good  state  of  nutrition. 
Nothing  is  needed  for  this  on  the  part  of  the  physician  but 
the  gift  of  persuasion.  But  this  process  takes  a  long  time, 
and  nothing  helps  the  treatment  like  isolation  and  rest  in  bed. 

The  subjects  being  young,  and  giving  no  reason  for  their 
refusal  to  take  food,  it  is  not  always  possible  to  confine 
one's  self  to  rational  persuasion,  and  it  is  necessary  to  add 
some  light  moral  constraint.  The  best  way  is  to  let  the  pa- 
tients understand,  with  the  moral  support  of  the  parents,  that 
they  will  not  be  allowed  to  return  home  until  they  are  cured. 

A  young  girl  was  attacked  with  this  form  of  wholly  mental 
anorexia.  At  the  end  of  several  days  the  Sister  who  took  care 
of  her  complained  that  she  had  not  been  able  to  accomplish 
anything.  The  young  girl  only  ate  if  she  was  forced  to  take 
each  mouthful.  "  Do  not  be  disturbed,  Sister,"  said  I,  before 
the  young  girl,  "  there  is  plenty  of  time ;  if  mademoiselle  eats 
well,  she  will  be  able  to  go  away  at  the  end  of  six  weeks ;  but 
if  she  does  not  succeed  in  doing  so,  it  will  take  about  eight  or 
ten  weeks;  but  that  makes  no  difference."  The  next  day  the 
young  girl  ate.  At  the  end  of  a  few  weeks  she  recognized 
with  astonishment  that  she  had  been  ill.  She  said :  "  I  was 
in  a  funny  condition,  and  I  can't  quite  make  it  out." 


OF  NERVOUS   DISORDERS         253 

However,  in  certain  cases  this  moral  constraint  is  not  ac- 
ceptable, and  leads  to  rebellion  on  the  part  of  the  patients. 

A  young  girl  seventeen  years  of  age  who  had  become, 
through  a  long  period  of  denutrition,  a  walking  skeleton  weigh- 
ing only  seventy-five  pounds,  had  made  some  progress  in  the 
first  six  weeks ;  but  as  the  anorexia  reappeared  and  threatened 
to  upset  everything,  I  thought  it  best  to  propose  an  additional 
treatment  of  a  fortnight.  The  patient,  frightened  by  this  pros- 
pect, thought  to  evade  it,  and  went  away  by  a  night  train  to  her 
home.  But  this  brusque  rupture  did  not  hinder  me  from 
attaining  my  ends.  I  warned  her  relatives  by  telegram,  and 
impressed  upon  them,  before  all,  not  to  reproach  the  patient. 
I  wrote  to  the  young  girl,  showing  her  the  emotions  which 
had  caused  her  flight;  then,  leaving  all  recriminations  out  of 
the  matter,  I  advised  her  to  go  on  with  the  treatment  of  over- 
feeding at  home.  As  they  say,  "  The  king  is  dead,  long  live 
the  king !  "  I  said :  "  The  treatment  has  not  succeeded ;  let  us 
begin  it  over  again  under  other  conditions."  The  patient,  hav- 
ing become  docile,  obeyed.  At  the  end  of  a  few  months  she 
announced  to  me  her  complete  cure  and  her  return  to  a  weight 
of  one  hundred  and  thirty  pounds.  Since  then  she  has  re- 
mained in  perfect  health. 

In  this  wholly  mental  form  of  anorexia  I  have  never  met 
with  a  failure,  altho  in  certain  cases  the  cure  has  been  delayed. 
The  conduct  remains  the  same  in  many  patients  in  whom  the 
anorexia  is  accompanied  by  vomiting  or  regurgitation.  Some- 
times these  troubles  cease  on  the  first  days  of  entrance  into 
the  sanitarium,  even  when  they  have  lasted  before  that  time 
for  months  or  years. 

It  is  not  always  possible  to  analyze  the  psychological  rea- 
sons for  these  sudden  changes,  for  these  patients  do  not  ex- 
press themselves  on  this  subject;  they  do  not  reveal  to  you 
their  secret  thoughts,  and  perhaps  they  could  not  do  it.  The 
fact  is  that  many  stop  vomiting  from  one  day  to  another. 

A  young  girl  seventeen  years  of  age,  mentally  anorexic, 
vomited  for  many  months  almost  all  that  she  took.  As  soon 
as  she  was  settled  in  the  sanitarium  I  indicated  to  her  that 
she  must  go  upon  a  milk  diet. 


254  PSYCHIC   TREATMENT 

"  But  my  daughter  can  not  bear  milk,"  said  the  mother  to 
me ;  "  she  vomits  even  if  she  takes  only  a  spoonful  in  her 
mouth." 

"  Don't  worry,  madam,  she  will  not  vomit,"  was  my  daring 
reply,  and,  in  fact,  she  never  did  vomit. 

A  little  girl  thirteen  years  of  age  had  also  vomited  for  a 
long  time.  She  had  taken  several  treatments,  always  accom- 
panied by  her  mother,  who  was  as  emotional  as  she.  I  iso- 
lated the  little  patient  and  won  her  confidence  by  not  being 
too  stern  with  her.  She  still  vomited  when  her  mother  was 
there.  By  my  advice  the  latter  went  away  the  same  evening, 
and  immediately  the  vomiting  stopped. 

In  older,  more  intelligent  patients  one  can  trace  the  mental 
representations  which  lead  to  the  cessation  of  the  symptoms. 
The  following  case  shows  the  stoicism  which  these  patients 
can  attain  when  they  have  understood  the  nature  of  their 
trouble. 

A  father  came  to  tell  me  the  story  of  his  daughter,  who 
had  for  three  years  suffered  with  gastric  troubles  and  ungov- 
ernable vomiting.  Her  state  of  emaciation  was  such  that  she 
actually  weighed  at  twenty-four  years  of  age  only  fifty-three 
pounds,  and  that,  after  she  had  attained  a  weight  of  one 
hundred  and  twenty-two  pounds  at  the  age  of  sixteen  years. 
Without  seeing  the  patient,  but  having  been  put  in  touch  with 
all  the  circumstances  which  had  brought  on  this  condition,  I 
did  not  hesitate  to  advise  rest  cure  and  overfeeding. 

The  father  would  have  been  quite  disposed  to  accept  it,  but 
he  said  there  was  an  insurmountable  obstacle :  the  young  girl, 
very  wilful,  absolutely  refused  to  enter  upon  any  treatment  of 
this  kind.  I  then  wrote  to  the  patient.  With  the  very  pre- 
cise information  which  her  father  had  given  me  as  a  founda- 
tion, I  described  her  whole  history  to  her  in  detail.  Without 
lying  and  without  exaggerating,  but  with  a  very  lively  desire 
to  win  her  confidence  by  praise,  I  referred  to  her  high  moral 
qualities,  the  altruism  of  which  she  had  always  given  evidence 
and  the  energy  in  work  which  she  had  shown.  Analyzing  the 
successive  states  of  mind  which  had  been  brought  about  by 
family  circumstances,  I  pointed  out  to  her  the  genesis  of  her 


OF  NERVOUS   DISORDERS         255 

trouble.  In  short,  describing  the  actual  state  of  affairs,  I 
placed  her  in  this  dilemma :  "  Either  you  will  continue  in 
this  way  (and  then  I  see  no  other  issue  but  death,  for  you  are 
on  the  verge  of  physiological  bankruptcy),  or  else  you  will 
bravely  put  yourself  upon  a  course  of  overfeeding  and  com- 
plete rest ;  and  these  two  measures,  cutting  down  the  expenses 
and  increasing  the  receipts,  will,  I  hope,  lead  to  your  cure." 

This  letter  had  a  decided  influence.  She  who  had  never 
even  wanted  to  see  a  physician  came  to  me  immediately,  and 
when,  by  word  of  mouth,  I  wanted  to  repeat  these  encourage- 
ments to  her,  she  said  to  me,  calmly :  "  That  is  not  necessary, 
doctor,  I  understood.  I  will  stay  in  bed  and  in  isolation  for 
I  understand  the  necessity  of  it.  I  will  not  vomit  any  more, 
and  I  will  eat  all  that  you  will  give  me !  "  The  brave  young 
woman  undertook  the  work  and  did  not  have  a  single  attack 
of  vomiting. 

One  could  believe  that  the  improvement  was  due  only  to 
the  physical  measures  and  rest  in  bed  and  purely  milk  diet  of 
the  first  few  days.  But  the  patient  had  just  tried  this  treat- 
ment in  another  sanitarium.  She  had  stayed  in  bed  several 
weeks,  and  had  taken  nothing  but  milk  in  small  quantities; 
nevertheless,  she  had  not  ceased  to  vomit.  This  was  because 
she  had  not  understood;  the  physician  had  not  been  able  to 
establish  in  his  patient  the  conviction  of  cure,  and  had  not 
known  how  clearly  to  show  her  the  means  of  obtaining  it. 

Unfortunately,  in  this  case,  this  intelligent  obedience  was 
not  to  be  rewarded.  Acute  phthisis  set  in.  I  immediately  dis- 
continued the  isolation,  in  order  to  allow  her  parents  to  nurse 
their  daughter  and  to  be  with  her  during  her  last  days.  If  the 
patient  had  asked  me  to  stop  the  overfeeding  that  I  had 
ordered  I  should  have  yielded  to  her  desire.  But  she  was 
started  in  a  certain  direction  and  persisted  in  it.  In  spite  of 
the  fever,  which  varied  from  102°  to  104°  F.,  in  spite  of  the 
dyspnea  of  sixty  respirations  which  left  her  scarcely  time 
to  swallow,  she  took  her  three  full  meals  and  milk  between 
two  of  them,  and  I  witnessed  the  strange  phenomenon  of  a 
patient  dying  of  acute  consumption  who  succeeded  each  week 
(and  that,  be  it  understood,  in  the  absence  of  all  dropsical 


256  PSYCHIC  TREATMENT 

phenomena)  in  making  a  gain  of  a  pound  in  weight.  The 
drama  came  to  an  end  in  five  weeks  by  a  sudden  pneumo- 
thorax. 

What  had  brought  about  the  suppression  of  the  vomiting 
and  made  the  overfeeding  possible  was  the  change  of  men- 
tality that  was  rationally  obtained  by  a  suggestive  letter. 

In  another  patient,  with  similar  anorexia,  who  had  also 
vomited  for  several  months,  the  conversation  took  place  under 
conditions  which  might  awaken  the  idea  of  simulation.  Con- 
trary to  what  generally  takes  place,  the  patient  continued  to 
vomit.  She  took,  obediently,  every  two  hours,  her  glass  of 
milk,  but  returned  it  a  few  minutes  later.  On  the  third  day 
the  Sister  on  the  service  called  my  attention  to  this  anomaly. 
"  It  is  curious,"  said  she,  "  this  is  the  first  of  our  patients  who 
has  continued  to  vomit  after  she  was  established  here.  I  be- 
lieve that  she  wants  to  eat,  because  she  asks  me  secretly  to 
give  her  some  bread,  which  I  naturally  refused." 

These  words  gave  me  an  idea.  I  went  up  to  the  patient; 
she  had  just  vomited  her  milk.  Then,  avoiding  all  tone  of 
reproach,  I  said  to  her,  quietly :  "  Mademoiselle,  I  find  myself 
in  a  good  deal  of  difficulty.  I  told  you  that  we  would  put 
you  upon  a  purely  milk  diet  for  six  days,  and  that  on  the 
seventh  day  we  should  be  able  to  get  to  a  hearty  and  varied 
diet.  But  I  am  very  sorry  to  see  that,  as  you  can  not  stand 
even  the  milk,  you  would  not  be  able  to  stand  the  rest.  It 
looks  as  tho  you  would  always  have  to  live  on  milk.  This  is 
a  very  trying  situation ! "  The  same  day  the  patient  ceased 
to  vomit. 

Basing  my  experience  on  a  great  many  observations,  I  do 
not  hesitate  to  state  that  psychopathic  anorexia,  with  or  with- 
out vomiting,  is  always  amenable  to  psychotherapy.  I  do  not, 
in  any  wise,  undervalue  the  favorable  influence  of  rest  and 
milk  diet.  I  know  also  that  with  those  patients  whose  mental 
condition  borders  on  insanity  isolation  is  imperative;  it  exer- 
cises an  efficacious  moral  restraint  upon  the  patients.  But 
the  cure  is  made  by  a  psychic  conversion  under  the  influence 
of  mental  representations.  Success  depends  upon  the  physi- 
cian's gift  of  persuasion. 


OF  NERVOUS   DISORDERS         257 

It  is  the  same  with  distaste  for  food,  sensations  of  con- 
striction of  the  esophagus,  which  seem  to  hinder  the  taking 
of  food,  and  pressure  on  the  epigastrium,  which  gives  the  pa- 
tient the  feeling  of  satiety  from  the  beginning  of  the  meal. 
The  moment  you  recognize  that  you  have  to  do  with  a  nervous 
patient,  you  should  give  up  all  aperients  and  antispasmodics. 
Show  the  patient  that  there  are  no  mechanical  obstacles  there ; 
insist  upon  the  mental  nature  of  the  disease ;  make  him  under- 
stand the  power  of  mental  representations ;  insist,  first  of  all, 
on  the  necessity  of  food,  and  on  the  imminent  danger  of  de- 
nutrition;  do  not  hesitate  to  hold  before  him  the  specter  of 
tuberculosis,  to  which  all  patients  in  a  poor  physiological  con- 
dition fall  a  prey;  you  will  thus  bring  him  back  without  any 
trouble  to  normal  alimentation. 

It  is  a  mistake  to  believe  that  these  educative  measures 
can  be  used  only  on  neurotics.  To  persuade  patients  and  make 
them  leap  over  obstacles  by  the  power  of  encouragement 
alone  is  necessary  in  the  majority  of  diseases.  To  the  phthis- 
ical patient,  who  pleads  his  lack  of  appetite  in  order  not  to 
eat,  I  do  not  give  remedies.  I  insist  when  I  am  with  him,  in 
order  to  get  the  idea  fixed  in  his  head,  that  he  must  eat, 
that  he  will  never  escape  from  the  bonds  of  disease  without 
strengthening  himself.  I  hammer  these  premises  into  his 
head.  Every  patient  with  lung  trouble  who  grows  thinner 
is  on  the  downward  path ;  if  he  grows  fat  it  is  a  fortunate 
sign.  And  I  add :  "  But  to  grow  fat  you  must  eat.  I  can 
not  get  away  from  that;  I  can  not  eat  for  you;  that  will  not 
fill  you  out !  " 

Then  the  patient,  somewhat  convinced,  replies :  "  I  will 
try,  doctor." 

"  Try,"  I  reply  to  him ;  "  that  is  no  good.  The  word  '  try  ' 
implies  an  idea  of  doubt  in  the  result,  and  doubt  always  di- 
minishes our  fervor ;  say :  '  I  will  do  it.'  " 

It  is  seldom  that  one  does  not  attain  the  end  by  these  simple 
counsels.  When  these  symptoms  are  present  I  renounce  all 
physical  means  ;  I  have  no  need  either  of  medicines,  or  douches, 
or  massage.  The  only  efficacious  weapon  is  the  word  of 
encouragement. 


258  PSYCHIC  TREATMENT 

The  plan  remains  the  same  in  the  various  dyspepsias  with 
eructations,  vomitings,  sharp  pain  and  heaviness  in  the  stom- 
ach, dilatation  and  gastroptosis.  It  is  bad  to  begin  the  treat- 
ment by  admitting,  in  such  cases,  a  primary  affection  of  the 
stomach,  or  "  stomachic  nervousness."  It  is,  on  the  contrary, 
the  stomach  which  suffers  from  the  counter  effect  of  the  nerv- 
ous condition.  Neurasthenia  is  not  localized  in  an  organ;  it 
is  mental. 

In  the  majority  of  cases  very  real  functional  disorders 
exist;  one  may  find  not  only  dilatation  but  hyperchlorhydria 
and  hypochlorhydria ;  the  motility  of  the  stomach  may  be  in- 
volved. But  all  these  troubles  are  secondary;  they  indicate 
nervous  depression.  It  is  easy  to  suppress  this  latter  by  moral 
means,  and  to  bring  the  patient  triumphantly  back  to  a  varied, 
hearty,  and  comforting  diet. 

I  dare  to  state  that  ninety  per  cent,  of  dyspeptics  are  psy- 
choneurotics,  and  that  all  these  patients  should  have  nothing 
to  do  with  restricted  diet  and  stomachic  medication.  It  is  on 
this  point  of  doctrine  that  I  differ  radically  from  the  great 
majority  of  my  confreres. 

I  know  very  well  that  by  entering  somewhat  into  the  views 
of  the  patient  one  can  treat  the  stomach  and  improve  the 
symptoms,  and  in  this  way  act  on  the  patient's  mind.  But 
for  one  neurasthenic  who  can  be  cured  by  this  indirect  thera- 
peutic suggestion  there  are  ten  who  owe  the  long  duration  of 
their  trouble,  and  sometimes  their  incurability,  to  this  method. 
I  often  see  patients  who  were  just  on  the  point  of  seeing 
clearly,  but  who  missed  it  through  their  autosuggestions,  and 
these  were  brought  about  by  their  physician.  Moreover,  there 
were  some  who  doubted  the  reality  of  their  trouble  and  who 
were  ready  to  neglect  it.  They  were  not  permitted  to  do  so. 
It  was  necessary  for  them  to  be  classified  and  have  a  name 
given  to  their  disease.  They  had  to  be  sick  according  to  the 
rules  of  the  profession. 

They  are  legion,  these  dyspeptic  patients,  who  visit  the 
watering-places  every  year,  and  who  are  never  able  to  eat 
anything,  but  who  are  always  in  pain.  At  the  start  they 
have  themselves  limited  their  diet;  for  example,  they  have 


OF  NERVOUS   DISORDERS         259 

drawn  the  line  at  cabbage  and  raw  things,  and  the  improve- 
ment obtained  seemed  to  show  that  they  were  right.  Later, 
the  gastric  troubles  having  reappeared,  they  have  suppressed 
some  other  food.  A  new  temporary  improvement,  but,  at  the 
same  time,  a  new  failure,  prompted  new  restrictions.  The 
physician  who  was  called  in  succeeded  in  washing  out  the 
stomach.  Then  the  patient  believed  himself  attacked  by  dila- 
tation of  the  stomach,  and  a  still  more  severe  regime  was 
prescribed.  Sometimes  the  patient  goes  to  a  stomach  special- 
ist who  is  a  conscientious  and  clever  man.  He  does  not  admit 
dilatation  at  the  outset ;  he  tests  it  by  insufflation,  and  analyzes 
the  gastric  contents  after  a  test  meal.  If  this  examination  is 
negative  the  patient  has  a  chance,  for  then  the  specialist  rec- 
ognizes that  he  is  a  "  nervous  case,"  and,  without  completely 
abolishing  his  rule  of  proportions,  he  will  be  able  to  improve 
the  condition  of  his  patient. 

But,  unfortunately  for  the  latter,  if  there  is  any  retention 
of  food  in  his  stomach,  or  hypoacidity,  or  if  there  is  an  excess 
of  mucus,  then  the  patient  must  remain  on  the  list  of  those 
suffering  from  gastric  disturbances.  He  must  undergo  lavage 
of  the  stomach,  and  must  submit  to  prescriptions  of  exclusive 
diet,  varying  only  according  to  the' theoretical  ideas  of  the 
physician  in  charge;  the  patient  may  be  condemned  to  swal- 
low raw  meat;  at  other  times  he  will  get  nothing  but  farina- 
ceous food.  One  physician  considers  milk  a  poison,  and  does 
not  hesitate  to  prescribe  wine  on  an  empty  stomach  or  to 
make  the  patient  eat  as  much  as  half  a  pound  of  sugar;  an- 
other will  put  his  patient  upon  a  prolonged  milk  treatment. 
Here  they  will  give  him  douches  on  the  epigastrium;  there 
they  will  electricize  him  inside  and  out.  At  last,  in  serious 
cases,  they  will  nourish  him  with  building  up  tonics  from  the 
drug-store — beef  juice  and  phosphates. 

And  always  the  patient  is  plunged  deeper  and  deeper  into 
his  gastric  hypochondria,  for  this  fixed  idea  has  been  carefully 
cultivated. 

Fortunately  it  is  not  so  tenacious  as  one  would  believe. 
The  poor  patients  have  already  done  a  little  reflecting  for 
themselves,  and  I  have  seen  some  who,  before  having  had 


260  PSYCHIC   TREATMENT 

my  advice,  said  to  me :  "I  believe  that  they  are  wrong  in 
treating  me  for  my  stomach;  it  seems  to  me  that  the  trouble 
is  rather  with  my  nerves !  "  There  are  some  even  who,  more 
royalist  than  the  king,  say  quite  frankly :  "  I  believe  that  I 
imagine  all  that !  " 

Does  this  mean  that  there  are  no  nervous  gastric  troubles? 
Evidently  not.  The  stomach  is  an  organ  too  often  ill  treated 
to  be  secured  against  idiopathic  affections.  The  constitutional 
conditions,  the  diseases  of  neighboring  glandular  organs,  the 
troubles  of  circulation  and  renal  affections  so  act  on  it  as  to 
cause  dyspeptic  conditions.  But  I  ought  to  say  that,  in  the 
medical  clientele,  these  affections  do  not  occur  every  day. 
The  practitioner  sees  in  a  year  several  cases  of  cancer  of  the 
stomach  and  a  few  round  ulcers.  He  will  have  to  care  for 
a  few  dyspepsias  which  have  been  caused  by  the  abuse  of  alco- 
holic drinks,  or  by  tobacco,  or  indiscretions  of  diet.  As  to  the 
gastric  troubles,  which  owe  their  origin  to  diathetic  condi- 
tions, to  valvular  affections  of  the  heart,  and  to  nephritis,  they 
are  frequent,  but  they  are  often  in  the  background  of  other 
more  threatening  symptoms,  and  it  is  only  once  in  a  while 
that  the  physician  has  recourse  to  symptomatic  medication  to 
combat  these  gastric  complications. 

Digestive  troubles  are  also  noticed  in  diseases  of  the  brain, 
whether  febrile  or  not,  in  meningitis,  and  in  general  paralysis. 
This  last,  above  all,  is  often  heralded  at  the  start  by  gastric 
troubles,  and  I  have  seen  physicians  persist  in  treating  pa- 
tients as  tho  they  had  dilatation  when  their  mental  condition 
was  so  disturbed  that  insanity  was  pronounced  and  confine- 
ment necessary. 

Melancholia,  hypochondria,  mania,  and  mental  symptoms 
of  circular  insanities  are  often  announced  by  anorexia,  bad 
taste  in  the  mouth,  nausea,  vomiting,  dyspepsia,  and  consti- 
pation— all  symptoms  of  what  has  been  called  nervous  dys- 
pepsia. 

The  alienists  seem  to  me  to  have  insisted  too  little  on  these 
gastro-intestinal  troubles.  They  observe  the  patient  only  in 
the  period  when  his  mental  troubles  dominate  the  scene.  The 
practitioner,  on  the  contrary,  sees  the  patients  from  the  start, 


OF  NERVOUS    DISORDERS          261 

when  they  still  seem  healthy  in  mind;  and  if  he  detects  in 
them  some  melancholy  mood,  he  is  easily  led  to  make  the  mis- 
take of  considering  it  as  secondary  and  caused  by  the  gastric 
pain. 

Do  not  go  about  repeating  the  statement  that  nothing 
affects  the  temper  like  diseases  of  the  stomach;  it  would  be 
better  to  say  that  nothing  troubles  the  functions  of  the  stom- 
ach like  moody  tempers. 

The  error  is  old,  and  the  impetuous  Broussais  1  seems  to 
have  originated  a  suggestion  which  still  persists  to-day.  It 
was  he  who  deliberately  put  the  cart  before  the  horse  when 
he  said :  "  There  is  never  any  gastro-enteritis  without  some 
degree  of  cerebral  irritation."  And,  further,  "  Hypochondria 
is,  in  effect,  a  chronic  gastro-enteritis  which  acts  forcibly  on 
a  brain  predisposed  to  irritation.  The  majority  of  dyspepsias, 
gastrodynias,  gastralgias,  pyroses,  cardialgias,  and  all  the 
cravings,  are  in  effect  chronic  gastro-enteritides." 

Sometimes,  nevertheless,  Broussais  recognized  the  psychic 
influence.  "  The  passions,"  he  says,  "  are  sensations  pro- 
voked, first  of  all,  by  instinct,  excited  and  exaggerated  by  the 
attention  which  intelligence  lends  to  them,  in  such  a  way  as 
to  make  them  predominant." 

The  influence  of  the  mental  representation  on  our  sen- 
sations is  distinctly  marked  in  these  words :  "  When  the  in- 
telligence is  occupied  with  ideas  relative  to  the  needs  of  the 
viscera  or  to  the  functions  of  a  sense,  the  nerves  of  the  viscera 
or  of  the  sense  are  always  in  action,  and  bring  sensations  into 
the  center  of  relation." 

As  I  have  indicated  in  a  previous  publication 2  Broussais 
found  contradictors  among  the  physicians  of  his  own  period. 

I  recommend  all  those  who  wish  to  examine  into  this  ques- 
tion clearly  to  read  a  book  of  Barras,  a  physician  of  Swiss 
origin,  who  enjoyed  great  notoriety  in  Paris  at  the  beginning 
of  the  last  century.  It  is  the  Traite  sur  les  gastralgies  et 


'  Examen  des  doctrines  mtdicala  et  des  systimes  de  nosologie.  Par  F.  J.  W.  Broussais. 
Paris,  1821. 

a  "Dcs  troubles  gastro-intestinaux  du  nervosisme."  Revue  de  Mldicine,  No.  7,  10 
juillet,  1900. 


262  PSYCHIC   TREATMENT 

enteralgies  ou  maladies  nervcuses  de  I'estomac  et  des  intestins. 
Paris,  1820. 

In  sixty  precise  and  concise  observations,  followed  by  ju- 
dicious reflections,  the  author  shows  the  preponderating  in- 
fluence of  the  emotions  in  the  etiology  of  nervousness  with 
gastric  manifestations.  He  rises  up  with  spirit  against  Brous- 
sais  and  the  physicians  of  the  period,  all  more  or  less  imbued 
with  the  so-called  physiological  doctrines,  and  who  tried  with 
all  their  strength  to  attribute  nervous  symptoms  to  a  chronic 
gastro-enteritis.  He  himself  was  the  subject  of  the  first  ob- 
servation, which  was  the  most  detailed  and  the  most  inter- 
esting. He  insisted  on  his  eminently  nervous  constitution  and 
his  taciturn  character  which  was  naturally  disposed  to  hypo- 
chondria. He  related  at  length  his  sufferings,  his  various 
neuralgias,  and  his  gastro-intestinal  troubles.  His  consulta- 
tions with  the  distinguished  practitioners  of  the  time  are  most 
interesting.  Many  of  them  were  not  very  psychological,  and 
only  succeeded  in  frightening  the  patient  and  plunging  him 
into  unhealthy  autosuggestions.  With  the  exception  of  one, 
all  were  convinced  of  the  presence  of  gastro-enteritis,  and 
fought  it  with  leeches  on  the  epigastrium,  gum  arabic  water, 
and  a  weakening  diet. 

His  condition  grew  worse  and  worse,  and,  in  spite  of  all, 
the  patient  persisted  in  this  dismal  way,  with  that  strange 
perseverance  which  I  have  noticed  as  one  of  the  characteristic 
symptoms  of  nervousness.  He  admitted  it  himself  in  these 
typical  words:  "And  nevertheless  I  continued  the  antiphlo- 
gistic regime  in  spite  of  this  formal  indication  to  give  it  up! 
I  can  not  explain  my  perseverance  in  a  treatment  so  contrary 
to  the  disease  with  which  I  was  afflicted." 

The  patient  was  cured  in  a  day.  His  daughter  was  at- 
tacked with  pulmonary  phthisis,  "  and,"  said  Barras,  "  from 
the  moment  my  attention  was  centered  entirely  upon  my  child 
I  thought  no  more  of  myself,  and  I  was  cured." 

One  should  read  the  discussions  to  which  this  cure  gave 
rise  in  the  medical  world.  Even  after  the  cure  the  battle 
continued,  and  one  of  the  sons  of  ^Esculapius  attempted  to 


OF  NERVOUS   DISORDERS         263 

prove  that  the  patient  never  had  been  cured — that  he  had 
always  been  unquestionably  afflicted  with  gastro-enteritis ! 

The  situation  is  the  same  to-day.  Dilatation  of  the  stom- 
ach has  replaced  the  famous  gastro-enteritis,  and  in  spite  of 
this  excellent  book  of  Barras  the  influence  of  the  mental  over 
the  physical  has  been  forgotten  anew. 

The  diagnosis  of  nervous  dyspepsia  is  generally  easy  to 
make  of  the  physician  knows  how  to  include  the  whole  per- 
sonality of  the  patient  in  his  inscrutable  glance.  In  certain 
cases  only  the  gastric  symptoms  seem  to  predominate  to  such 
a  degree  that  it  becomes  necessary  to  make  a  thorough  ex- 
amination of  the  stomach.  One  should  determine  the  shape 
and  position  by  palpation,  and  should  resort  to  percussion,  and 
even  look  at  it  with  the  X-rays.  One  should  analyze  the 
vomitus,  test  the  acidity,  and  give  a  test  meal.  But  I  ought 
to  say  that  when  one  is  quite  familiar  with  the  dyspepsia  of 
nervous  patients  it  is  rarely  necessary  to  resort  to  these 
measures. 

What  strikes  me,  from  the  first  conversation,  are  the  con- 
tradictions which  the  patient  makes.  When  he  is  asked, 
"  Have  you  any  appetite  ?  "  the  response  varies.  One  says : 
"  I  could  have  an  appetite,  but  I  do  not  dare  to  eat."  An- 
other has  an  irregular  appetite — "  capricious."  A  third  claims 
that  he  can  stand  a  heavy  meal  one  day,  but  that  he  is  often 
disturbed  by  some  food  that  is  easily  digested.  Many  patients 
indicate  at  the  start  the  influence  of  emotions.  "  It  is  annoy- 
ances which  do  me  the  most  harm;  with  me  everything  goes 
to  my  stomach !  " 

If  you  inquire  concerning  the  intestinal  functions,  you  will 
see  that  the  majority  of  the  patients  are  troubled  with  habitual 
constipation.  More  rarely  they  are  subject  to  diarrhea,  and 
here  again  one  notices  the  effect  of  the  emotions.  The  ex- 
pectation of  an  event  or  of  a  journey  is  enough  to  provoke  the 
intestinal  flow.  The  sleep  is  generally  disturbed.  There  is 
insomnia,  and  distressing  dreams.  These  are  symptoms  which 
are  quite  foreign  to  the  symptomatology  of  gastric  affections, 
or  of  cancer,  or  of  round  ulcer,  or  of  the  organic  dyspepsias. 

But  chiefly  the  conversation  with  the  patient  reveals  a  whole 


264  PSYCHIC   TREATMENT 

series  of  symptoms  which  can  not  be  the  consequence  of  a 
dyspeptic  condition. 

The  patient  suffers  from  headaches,  which  often  suddenly 
replace  the  dyspepsia,  taking  its  place  for  some  weeks,  months, 
or  even  years.  It  is  not  rare  that  from  one  day  to  another 
the  transfer  is  made  in  the  inverse  sense,  and  that  the  head- 
aches cease  and  the  whole  train  of  dyspeptic  symptoms  re- 
appear. The  patient  has  neurasthenic  backaches,  palpitation, 
without  lesion  of  the  heart.  He  has  pains  which  remind  one 
of  precordial  anguish.  He  is  impressionable,  emotional,  and 
easily  tired.  Often  you  detect  his  irrationalism :  he  is  head- 
strong, superstitious,  and  curious  about  spiritual  phenomena. 
He  attributes  his  dyspeptic  troubles  to  foreign  causes,  like 
the  subject  of  whom  I  spoke  who  was  made  sick  by  the  sight 
of  red.  In  many  cases  the  purely  hypochondriacal  condition 
is  evident  in  this  sense:  that  the  examination  establishes  the 
excellent  functioning  of  the  stomach  and  the  intestines.  These 
are  the  cases  which  have  given  rise  to  the  saying  that  nervous 
dyspepsia  is  that  in  which  there  are  subjective  symptoms  of 
dyspepsia  when  the  examination  shows  the  integrity  of  the 
organs  and  their  functions.  This  is  only  true  in  the  minority 
of  cases.  More  often  there  is  true  dyspepsia. 

As  soon  as  one  has  recognized  the  nervousness  one  may  go 
further,  and  briskly  bring  the  patient  back  to  healthy  habits 
of  living  and  cure  him  by  simple  persuasion. 

Always  ready  to  revise  my  views  and  criticize  my  own 
observations,  I  have  sometimes  been  afraid  of  making  an 
idol  of  my  own  opinion  and  of  abusing  the  terms  "  nervous  " 
and  "  psychic."  I  have  been  able  to  prove,  on  the  contrary, 
that  I  have  been  too  timid.  It  is,  in  fact,  easy  to  exclude  the 
organic  defections,  to  reveal  the  ideogenic,  hypochondriacal, 
or  emotional  origin  of  the  symptoms ;  then,  without  any  hesi- 
tation, one  must  have  recourse  to  direct  psychotherapy. 


OF  NERVOUS   DISORDERS          265 


CHAPTER   XXI 

Treatment  for  Dyspeptics — Rest,  Isolation,  and  Preparatory  Milk  Diet — 
Building  Up  by  Overfeeding  -Massage — The  Value  of  these  Meas. 
ures  —  Necessity  of  Inducing  Obedience  by  Persuasion  —  Results  of 
the  Treatment  and  Examples 

I  HAVE  said  that  in  serious  and  stubborn  cases  it  is  neces- 
sary to  place  the  patient  in  conditions  which  facilitate  mental 
treatment,  and  I  have  indicated  as  particularly  favorable  the 
measures  known  as  Weir  Mitchell's.  Further,  one  can  often 
dispense  with  isolation  and  rest  and  all  physical  measures,  and 
confine  one's  self  to  psychotherapeutic  influence.  But  one  must 
have  already  had  a  vast  therapeutic  experience  to  pass  over 
these  aids,  and  I  do  not  advise  the  beginner  to  go  to  the 
combat  without  these  weapons. 

I  ought  also  to  recommend  to  the  physician  who  desires  to 
ascertain  the  efficacy  of  these  measures  to  be  at  first  quite 
severe  and  to  propose  to  his  patient  a  plan  of  exact  treat- 
ment without  imprudent  concessions.  I  insist  on  these  im- 
portant details,  and  I  shall  proceed  to  describe  them  exactly. 

You  have  before  you,  I  will  suppose,  a  lady  who  complains 
of  gastric  troubles,  anorexia,  nausea,  eructations,  distention, 
and  perhaps  vomiting.  She  is  emaciated  to  the  last  degree, 
weighs  forty  or  fifty  pounds  less  than  in  the  periods  of  her 
life  when  she  was  in  good  health.  Her  tongue  is  slightly 
coated,  her  stomach  temporarily  dilated  and  disturbed.  She 
is  habitually  constipated.  In  short,  you  detect  in  her  the 
whole  procession  of  nervous  symptoms  and  the  mental  stig- 
mata in  particular. 

If  you  have  any  doubts  on  the  question  of  a  gastric  trouble 
grafted  on  to  the  nervousness,  suspend  your  judgment  and 
examine  the  stomach  by  all  the  clinical  methods.  But  when 
you  have  reached  the  certainty  that  it  is  a  question  wholly  of 
nervous  dyspepsia,  do  not  hesitate  any  longer  to  propose  to 
your  patient  a  treatment  which  consists  of: 


266  PSYCHIC  TREATMENT 

1.  A  stay  of  about  two  months  in  a  well-organized  sani- 
tarium.    The  patient  will  protest,  saying  that  it  is  very  long. 
Make  the  reply  that  it  is  short  when  it  is  a  question  of  a 
trouble  which  has  lasted  for  years.     Amplify  this  theme,  and 
soon  you  will  be  granted  more  time  than  you  have  asked. 
The  success  depends  only  on  your  convincing  conversation. 

2.  Complete  rest  in  bed  for  the  first  six  weeks.     New  re- 
criminations will  reach  you  for  this  advice,  but  they  will  be 
just  as  easy  to  dissipate. 

Sometimes  the  patient  sighs  for  this  rest  and  accepts 
it  from  the  start.  If  she  does  not  see  the  reason  for  it,  call 
her  attention  to  the  fact  that  the  exhaustion  indicates  this 
measure,  and  that  when  one  takes  rest  one  can  not  take  too 
much  of  it.  Show  her  that  one  could  perhaps  attain  the  end 
with  a  less  complete  rest,  but  then  it  would  take  four  months 
for  the  treatment  instead  of  two!  Your  patient  will  then 
concur  in  your  opinion. 

3.  Isolation.  Here  a  patient  will  stop  you  and  declare: 
"  I  could  never  stand  that  measure ! "  If  your  patient  is 
emotional,  if  she  is  one  of  those  who  take  all  the  trifling 
events  of  life  tragically,  if  the  family  conditions  are  such 
that  letters  would  lead  to  vexations,  do  not  make  concessions, 
but  refuse  to  undertake  the  treatment  under  any  other  con- 
ditions than  those  that  you  have  fixed.  If  you  thus  offer  to 
break  off  the  bargain  your  patient  will  accept  your  conditions. 

But  do  not  be  unnecessarily  severe.  If  the  patient  wishes 
to  preserve  some  slight  epistolary  relations  with  a  person  who 
could  exercise  only  a  good  influenc,  if  she  wants  a  chamber- 
maid who  will  undertake  to  work  in  the  interests  of  the  phy- 
sician, if,  even,  a  reasonable  husband  (for  there  are  such) 
wants,  from  time  to  time,  to  make  little  visits,  you  may  yield ; 
but  only  do  it  when  you  are  sure  of  not  compromising  the 
treatment.  In  general,  complete  isolation,  without  letters  and 
without  visits,  is  worth  more.  It  is  for  you  to  know  so  well 
how  to  describe  to  your  patient  the  value  of  these  measures 
that  she  will  accept  them  spontaneously.  She  must  understand 
them  so  perfectly  that  she  would  rather  be  disposed  to  refuse 
concessions  than  to  demand  them. 


OF  NERVOUS   DISORDERS 


267 


Here,  then,  you  have  your  patient  installed,  ready  to  fol- 
low your  advice,  and  the  question  is  now  to  bring  her  back 
to  normal  alimentation,  or,  rather,  to  the  state  of  overfeeding. 

In  certain  cases  one  can  put  her  upon  this  feeding  from 
the  start,  but  it  is  wise  not  to  offend  too  rudely  her  long-es- 
tablished autosuggestions,  and  to  start  out,  for  the  sake  of 
assuring  the  future,  with  a  light  preparatory  milk  treatment. 
It  is  useless  to  prolong  this  milk  diet  for  whole  weeks;  it  will 
impose  upon  the  patient's  willingness. 

Six  days,  I  have  said,  have  always  been  sufficient  for  me 
to  prepare  the  stomach  for  the  overfeeding  which  will  follow. 
Often  the  patient  will  tell  you  that  she  can  not  bear  milk. 
Do  not  let  yourself  be  put  out  of  countenance,  but  state  what 
is  true:  that  milk  is  the  most  complete  and  the  most  easy  to 
tolerate  of  all  foods.  It  is  useless  to  hurt  the  patient  by  say- 
ing, clumsily :  "  Those  are  only  your  ideas ;  you  imagine  all 
that !  "  No ;  state  simply  your  convictions  based  on  your  long 
experience.  Cite  cases  to  support  it.  Nothing  by  force,  every- 
thing by  gentleness,  ought  to  be  the  motto  of  the  psychothera- 
peutist. 

I  have  been  accustomed  to  make  out  in  writing  a  plan  of 
this  milk  treatment  in  the  following  form  (i  dose  =  3  ounces)  : 


HOURS   OF   DAY 

7 

9 

II 

I 

3 

5 

7 

9 

Second  Day..  .  . 

I* 

i% 

I* 

Itf 

i# 

i* 

& 

itf 

36  ounces 

Third  Day  

2 

2 

2 

2 

2 

2 

i 

2 

48  ounces 

Fourth  Day.  .  .  . 

3 

2 

2 

3 

2 

2 

3 

2 

57  ounces 

Fifth  Day  

4 

2 

2 

3 

2 

2 

3 

2 

60  ounces 

Sixth  Day  

4 

2 

2 

3 

2 

2 

3 

2 

60  ounces 

On  the  sixth  day  add  bread,  butter,  sweets,  or  honey  at  the  first 
meal,  with  the  12  ounces  of  milk. 


268  PSYCHIC   TREATMENT 

The  milk  ought  to  be  drunk  slowly  in  little  swallows.  I 
usually  give  it  boiled  and  hot.  The  hours  of  the  three  future 
meals  are  marked  by  the  larger  quantities  of  milk  at  seven, 
one,  and  seven  o'clock. 

In  ninety-eight  out  of  a  hundred  patients  this  diet  is  borne 
without  difficulty.  If  the  patient  complains  of  a  bad  taste  in 
the  mouth  and  shows  you  her  white  tongue,  make  the  obser- 
vation that  that  always  happens  with  the  liquid  diet  of  milk, 
but  that  it  will  completely  disappear  by  mastication,  which  is 
the  only  thing  that  will  clean  the  tongue.  If  there  is  any 
distention,  or  eructation,  or  acidity,  or  even  some  vomiting, 
or  a  little  diarrhea,  persuade  the  patient  gently  not  to  pay  any 
attention  to  it ;  say  that  it  will  pass  away.  Sometimes  a  diar- 
rhea may  be  overcome  by  lime-water,  or  by  a  few  doses  of 
opium.  Finally,  the  milk  rarely  produces  a  laxative  effect, 
which  necessitates  the  suspension  of  the  milk  diet.  This  pe- 
riod can  then  be  cut  short,  and  one  can  pass  boldly  on  to 
overfeeding. 

On  the  seventh  day  the  regimen  changes  abruptly,  and 
without  transition  you  will  prescribe:  Breakfast — Twelve 
ounces  of  milk;  bread,  butter,  honey,  or  preserves.  At  ten 
o'clock  in  the  morning,  eight  ounces  of  milk.  For  lunch  (or 
dinner),  a  full  meal  without  permitting  any  choice.  This 
should  be  varied  and  copious,  but  without  wine.  At  four 
o'clock  take  eight  ounces  of  milk.  Dinner  (or  supper)  should 
be  equally  copious.  At  nine  o'clock  eight  ounces  of  milk 
should  be  taken. 

If  you  have  the  gift  of  persuasion  you  will  always  succeed. 
Dispel  all  fears,  and  insist  upon  the  necessity  of  overfeeding 
in  order  quickly  to  get  out  of  the  condition  of  malnutrition. 
If  patients  say  they  can  not  eat  because  it  makes  them 
constipated,  make  them  understand  that  an  abundant  diet  is 
the  very  best  remedy  against  constipation;  that  the  fecal 
materials  are  the  dross  of  the  digestion,  and  that  in  order 
to  have  easy  and  regular  movements  the  food  must  contain 
enough  undigestible  matter,  such  as  cellulose,  to  clear  out  the 
intestine.  Large  eaters  are  never  constipated !  Teach  the 
patient  to  accustom  his  intestines  to  regular  evacuations. 


OF  NERVOUS   DISORDERS         269 

When  constipation  lasts  more  than  three  days,  prescribe 
an  enema,  and,  if  it  does  not  succeed,  give  it  abundantly,  with 
nearly  a  quart  of  warm  water,  and  make  the  patient  take  it 
in  the  knee-elbow  position,  with  the  buttocks  raised  in  such 
a  way  as  to  let  the  liquid  flow  as  far  as  the  transverse  colon 
and  to  the  caecum.  Get  the  patient  to  retain  the  enema  a 
quarter  of  an  hour.  The  large  intestine  will  be  relieved. 

I  hold  that  in  all  cases  of  nervous  dyspepsia,  and  that  is 
the  most  frequent  of  the  dyspepsias,  this  regime  of  overfeed- 
ing is  always  well  borne. 

If  your  patient  complains  of  the  persistence  of  any  troubles, 
take  care  not  to  treat  these  discomforts  as  tho  they  were  of 
no  consequence.  On  the  contrary,  sympathize  with  your  pa- 
tient, point  out  to  him  that  nothing  can  be  obtained  without 
effort,  and  that,  in  his  case,  where  the  dyspepsia  has  lasted 
for  years,  it  is  not  remarkable  that  overfeeding  should  pro- 
duce some  slight  disturbance.  Drop  the  remark  that  he  has 
taken  every  precaution  for  years,  and  lived  according  to  re- 
strictions without  having  arrived  at  any  result.  He  will  then 
understand  that  it  would  be  wise  to  return  to  his  course  of 
treatment  and  put  himself  bravely  upon  a  building-up  diet. 

But,  it  will  be  said,  why  overfeeding?  I  have  already  said 
why,  but  I  repeat  the  injunction.  Because  it  leads  rapidly  to 
an  improvement  of  the  general  condition  which  acts  physically 
and  morally  on  the  patient :  physically,  because  he  is  in  a  state 
of  physiological  misery;  morally,  because  the  proof  of  this 
progress  encourages  him.  Success  shows  the  patient  the  fool- 
ishness of  his  former  fears.  Normal  alimentation  is  not  suffi- 
cient to  attain  this  double  end.  It  leads  only  to  slow  progress, 
which  does  not  encourage  the  patient  who  is  always  disposed 
to  pessimism. 

The  effect  of  this  treatment,  from  the  point  of  view  of 
nutrition,  naturally  varies  according  to  cases.  The  first  week, 
in  which  the  food  is  still  insufficient,  does  not,  as  a  rule,  show 
any  increase  of  bodily  weight. 

Patients  who  ate  very  copiously  before,  grow  thin.  They 
may  lose  in  the  first  seven  days  from  one  to  seven  pounds. 
There  are  some  who  remain  stationary,  their  usual  insufficient 


270  PSYCHIC  TREATMENT 

diet  being  about  equivalent  to  the  milk  diet.  Only  those  who 
are  very  much  emaciated  succeed  in  gaining  during  the  first 
week  as  much  as  one,  two,  or  three  pounds. 

The  result  of  the  first  week  does  not  matter,  but  it  is 
wise  to  have  warned  the  patient  about  it  before  weighing  him, 
for  he  is  always  disposed  to  put  an  unfavorable  interpretation 
upon  whatever  loss  of  weight  he  may  experience. 

At  the  end  of  the  second  week  there  should  be  a  marked 
increase.  The  more  it  grows,  the  more  it  determines  the 
mental  and  physical  well-being.  The  increase  may  vary  from 
two  and  a  half  to  ten  pounds.  The  amount  of  seven  pounds 
in  a  week,  and  even  a  pound  and  a  quarter  a  day,  is  not 
rare,  and  I  have  seen  as  great  an  increase  as  eleven  pounds 
and  a  half  in  a  week. 

One  must  remember  to  congratulate  the  patients  who  have 
succeeded,  and  especially  to  reassure  those  who  have  not  made 
sufficient  gain.  It  is  useless  to  use  authority  and  to  treat 
the  patient  brusquely.  It  is  sufficient  to  say  to  him :  "  You 
have  not  succeeded  this  week;  well,  you  will  succeed  next 
week !  "  The  evidence  of  failure  must  not  discourage  you ; 
the  only  conclusion  to  draw  is  that  we  must  do  better  next 
time. 

A  few  examples  will  prove  the  efficacy  of  these  measures 
when  one  knows  how  to  put  the  necessity  of  them  to  the 
patients. 

Mile.  C was  a  neurotic,  fifty-one  years  of  age,  who 

who  had  for  several  years  suffered  intense  cardiac  pains,  pre- 
venting the  taking  of  food.  She  had  been  in  bed  for  a  year, 
and  could  not  take  more  than  a  cup  of  tea  with  a  little  milk 
and  a  roll  in  twenty-four  hours. 

Thus  she  had  fallen  to  ninety  pounds  when  her  height 
of  five  feet  and  eight  inches  required  a  weight  of  nearly  one 
hundred  and  seventy-five  pounds.  She  had  the  yellow  color 
and  the  nasolabial  furrows  of  a  cancerous  cachexia.  Her 
skin  remained  in  a  fold  when  one  pinched  it  together.  All 
attempts  made  by  two  very  energetic  physicians  to  establish 
this  patient  on  a  better  diet  had  not  succeeded;  she  had  not 
even  been  able  to  bear  a  little  Revalesciere. 


OF  NERVOUS  DISORDERS          271 

The  patient  desiring  to  enter  my  sanitarium,  I  yielded  to 
her  wish,  but  not  without  setting  before  her  with  an  air  of 
pleasantry  my  conditions.  "  You  are  not  obliged  to  do  any- 
thing, mademoiselle;  I  never  use  authority.  But  if  you  want 
to  get  out  of  there,  and  it  seems  to  me  that  that  would 
naturally  be  your  desire,  you  will  have  to  drink  milk  in  in- 
creasing doses ;  then  you  will  have  to  enter  boldly  upon 
a  course  of  overfeeding,  which  will  rapidly  increase  your 
weight.  You  can  complain  if  you  need  to,  but  you  will 
pardon  me  if  on  this  occasion  I  show  a  very  Platonic  sym- 
pathy. It  is  probable  that  I  shall  not  change  your  regimen 
at  all,  for  my  experience  has  always  confirmed  one  idea, 
the  result  of  reason,  and  that  is  a  knowledge  of  the  fact 
that  to  shrink  back  before  obstacles  is  not  to  overcome  them." 

The  patient  came.  She  stood  the  milk  diet  for  six  days 
without  the  slightest  trouble.  On  the  seventh  day  she  began 
to  eat  without  any  hesitation,  and  she  overfed  herself  so  well 
that  in  the  second  week  she  made  a  gain  of  ten  pounds! 

Once  only,  in  the  course  of  the  second  month,  she  said: 
"  Doctor,  I  dare  not  take  my  milk  at  four  o'clock,  for  I  still 
have  all  my  dinner  in  my  stomach !  "  After  having  exam- 
ined the  stomachic  region  I  ascertained  that  there  was  no 
symptom  of  distention  whatsoever,  and  advised  the  patient  to 
take  her  milk.  The  next  day  she  said  to  me :  "  You  were 
right:  not  only  did  the  milk  do  me  no  harm,  but,  on  the 
contrary,  it  took  away  the  feeling  of  fulness  which  I  experi- 
enced." 

This  was  the  only  timid  attempt  at  rebellion  which  the 
patient  showed.  She  left  the  sanitarium  cured,  weighing  one 
hundred  and  thirty-three  pounds.  She  has  not  gone  back 
to  her  state  of  ill  health,  altho  the  cares  in  her  family,  which 
had  been  a  prominent  factor  in  causing  her  sickness,  were 
still  burdensome  to  her. 

M.  X.  was  a  lawyer  thirty-six  years  of  age,  of  tall 
stature,  nearly  five  feet  and  eleven  inches,  who,  as  a  result  of 
overwork,  had  developed  a  neurasthenic  condition. 

Anorexia  was  complete,  the  tongue  coated,  and  the  patient 
could  not  stand  anything  at  all.  Milk,  even  in  small  doses, 


272  PSYCHIC   TREATMENT 

caused  gastric  troubles,  and  in  spite  of  rest  in  the  country 
and  the  advice  of  a  specialist  for  stomach  diseases  his  con- 
dition had  only  grown  worse.  Moreover,  the  patient  had 
reached  a  weight  of  one  hundred  and  thirty-five  pounds,  about 
seventy-five  pounds  less  than  his  normal  weight.  His  dis- 
couraged physician  sent  him  to  me,  saying  that  he  had  never 
before  seen  such  a  rebellious  case  or  such  a  refractory  disease. 

My  patient  arrived  four  days  before  my  departure  for  my 
vacation.  He  proposed  to  undergo  the  treatment,  but  to  be 
free  to  go  to  some  one  else  during  my  absence.  I  accepted, 
but  said  to  him :  "  In  this  case  the  moral  treatment  will  have 
to  take  place  in  these  four  days,  for  my  confrere,  who  is  ex- 
cellent on  the  material  side,  has  not  been  able,  perhaps,  to 
convince  you.  A  sudden  conversion  is  necessary  in  your  case. 
You  are  going  to  begin  on  a  milk  diet." 

"  But,  doctor,  I  can  not  take  milk.  For  forty  days  I  have 
not  been  able  to  take  anything !  " 

"And  you  want  to  continue  like  that?  Your  answer  is 
no,  is  it  not?  Then,  as  milk  is  the  easiest  of  all  foods  to 
digest,  you  have  got  to  begin  on  that !  " 

The  following  day  my  patient  announced  to  me  that  he 
had  digested  his  food  very  well.  On  the  fourth  day,  on  the 
eve  of  my  departure,  I  said  to  him :  "  You  are  going  to  con- 
tinue milk  in  increasing  doses  until  the  seventh  day;  then  you 
will  take  three  full  meals,  without  any  choice,  and  milk  be- 
tween meals." 

"  But,  doctor,  you  must  remember  that  it  is  a  long  time 
since  I  have  been  able  to  take  anything !  " 

"  Now  I  will  ask  you  once  more,  do  you  want  to  remain 
in  this  distressing  situation?  Eat,  I  tell  you!  You  have  al- 
ready protested  against  milk;  but  you  have  stood  it  splen- 
didly. Now,  remember  my  advice,  three  full  meals,  without 
any  choice,  and  milk  between  two  of  them." 

On  my  return  the  physician  who  took  my  place  told  me 
that  he  had  not  had  the  slightest  trouble  in  treating  the  pa- 
tient in  the  prescribed  way.  In  five  weeks  he  had  gained 
thirty-one  pounds. 

M.  G ,  a  lawyer  thirty-five  years  of  age,  was  slightly 


OF   NERVOUS    DISORDERS          273 

unbalanced  and  haunted  by  the  idea  of  gout,  and,  in  addition 
to  innumerable  nervous  troubles,  had  trouble  with  his  stom- 
ach, and  for  fifteen  years  had  lived  upon  a  restricted  diet. 
His  physician  had  not  been  able  to  make  him  take  strength- 
ening food ;  he  weighed  one  hundred  and  twenty-nine  pounds, 
whereas  he  had  formerly  weighed  one  hundred  and  eighty- 
eight  pounds.  He  was  constipated,  and  had  an  antipathy  to 
all  remedies;  he  accused  his  physician  of  having  made  him 
sick  by  giving  him  a  glass  of  Chatel-Guion  water. 

I  succeeded  in  a  single  conversation  in  suppressing  all  his 
prejudices.  From  the  first  week,  during  the  milk  diet,  he 
gained  three  pounds  and  a  half;  in  the  second  he  gained  over 
eleven  pounds;  and  at  the  end  of  eight  weeks  he  had  gained 
forty-three  pounds,  and  for  six  months  he  lived  a  perfectly 
normal  life. 

This  patient,  who  was  undeniably  a  hypochondriac,  fell 
back  later  into  his  fixed  ideas  concerning  his  inability  to  digest 
anything.  I  could  not  then  succeed  in  convincing  him,  and 
he  returned  home  and  let  himself  die  of  inanition.  I  do  not 
know  whether  in  the  end  he  committed  suicide.  But  in  the 
first  attack,  in  spite  of  the  decidedly  psychotic  nature  of  the 
disease,  I  was  able  to  overcome  the  patient's  resistence. 

As  I  have  written  in  my  article  already  cited,1  I  could  count, 
without  any  exaggeration,  hundreds  of  cases  of  more  or  less 
severe  gastro-intestinal  dyspepsia  which  I  have  passed  on 
from  a  restricted  diet  which  had  proved  inefficacious  to  de- 
cided overfeeding.  I  have  never  had  symptoms  which  have 
obliged  me  to  go  back,  and  these  patients  have  succeeded  in 
continuing  this  kind  of  eating  without  disordering  the  stom- 
ach; not  only  have  they  regained  their  strength  and  their 
normal  embonpoint,  but  they  have  lost  wholly  or  in  part 
the  various  nervous  troubles  which  accompanied  their  dys- 
pepsia, not  in  consequence  of  the  latter,  but  as  concomitant 
symptoms  of  nervousness. 

It  is  clear  that  this  treatment,  which  consists  in  using  a 
persuasive  influence  to  win  patients  over  to  treatment  by  over- 

*  "  Des  troubles  gastro-intestinaiuc  du  nervosisme."  Revue  de  Mtdicine,  No.  7,  10 
juUlet,  1900. 


274  PSYCHIC   TREATMENT 

feeding,  might  have  dangers  when  there  was  a  question  of 
organic  trouble,  such  as  cancer  or  round  ulcer.  Rest  in  bed 
and  simple  milk  diet  always  give  direct  benefits  to  the  di- 
gestive functions,  and  I  have  been  able  to  bring  about  in 
a  cancerous  patient  who  refv.sed  operative  intervention  the 
cessation  of  vomiting  and  of  pain,  and  a  regular  increase  of 
weight  of  one  pound  a  week.  This  method  of  treatment  is 
also  applied  with  advantage  to  all  conditions  of  lack  of  nu- 
trition, anemia,  dyspeptic  headaches,  and  constipation.  I  have 
seen  rebellious  headaches  of  long  standing  stop  under  the 
influence  of  this  fortifying  treatment.  But  it  is  chiefly  when 
one  has  determined  the  nervous  and  psychic  nature  of  the 
dyspepsia  that  this  treatment  may  be  energetically  and  un- 
hesitatingly applied. 

For,  as  I  have  said,  and  as  I  will  repeat,  the  diagnosis 
of  nervous  dyspepsia  is  not  based,  as  a  rule,  on  the  examina- 
tion of  the  stomach  and  on  chemical  investigations.  It  is  by 
the  observation  of  the  patient  that  one  is  able  to  detect  in 
him  the  mental  peculiarities  of  nervousness,  or  psychopathy. 
That  is  why  it  is  so  easy  to  cure  such  patients  by  rational 
psychotherapy. 

One  may,  however,  obtain  the  same  results  by  hypnosis 
and  plain  suggestion,  by  intimidation  or  threats.  The  gastro- 
intestinal troubles  are  also  as  amenable  to  this  somewhat  un- 
certain therapeutic  treatment,  as  are  spasms,  contractures,  and 
sleeplessness,  etc.  But  I  do  not  like  such  measures. 

My  old  friend,  Professor  Dejerine,  of  Paris,  has,  for  a 
long  time,  used  this  psychotherapy  which  I  prescribe  in  his 
practise.  He  has  had  the  merit  of  applying  it  in  the  hospital, 
and  he  has  shown  that  it  is  possible  to  obtain  excellent  results 
under  these  conditions.  He  expresses  himself  thus : * 

"  Since  1895,  the  period  at  which  I  began  to  use  this 
method  of  treatment  at  La  Salpetriere,  I  have  applied  it  to 
about  two  hundred  cases  of  psychoneuroses,  hysteria,  neur- 
asthenia, hysteroneurasthenia,  mental  anorexia,  uncontrollable 
vomiting,  etc.  The  observation  of  a  certain  number  of  pa- 

1  "  lye  traitement  des  psychoneuroses  k  1'hopital  par  la  mdthode  de  1'lsoletnent." 
Revue  neurologique,  No  15,  deceinbre,  1902. 


OF  NERVOUS   DISORDERS         275 

tients  attacked  by  various  forms  of  hysteria  have  been  pub- 
lished in  the  thesis  of  my  assistant,  Manto;2  others  will  be 
the  subject  of  a  more  extended  work  which  will  be  pub- 
lished in  the  near  future  by  my  internes,  MM.  Pagniez  and 
Camus.  For,  of  these  two  hundred  cases  of  psychoneu- 
roses  which  have  passed  through  my  service  in  the  last  seven 
years,  I  have  only  had  to  register  two  failures.  I  have  had 
to  do  with  very  serious  cases  of  hysteria  and  mental  anor- 
exias which  entered  into  the  service  in  a  condition  of  extreme 
cachexia;  neurasthenics  having  lost  a  third  or  half  of  their 
weight,  and  having  symptoms  of  a  hypochondriacal  or  melan- 
cholic state;  functional  gastropathies  that  had  been  treated 
without  success  for  months  and  even  years  by  gastro-thera- 
peutics,  the  action  of  which  had  for  the  most  part  been  harm- 
ful, for  it  had  impressed  still  more  markedly  upon  the  brain 
of  the  patient — by  the  examination  of  the  gastric  juice,  lavage 
of  the  stomach,  and  regulations  as  to  diet — the  idea  of  a  true 
stomachic  affection.  Often,  in  short,  colleagues  from  the  hos- 
pitals have  sent  me  neuropaths  who  were  deeply  affected, 
having  spent  a  greater  or  less  length  of  time  in  their  service. 
But,  in  all  cases,  as  well  in  those  that  were  serious  as  in 
those  of  lesser  intensity,  I  have  always  obtained  favorable 
results,  and  I  mean  by  that  not  merely  a  more  or  less  marked 
improvement,  but  true  cures.  I  will  add,  in  conclusion,  that, 
during  the  eight  years  that  I  have  been  at  La  Salpetriere  the 
symptoms  have  never  lasted  a  week  in  my  service." 

From  the  point  of  view  of  the  gravity  of  the  cases  I  find 
myself  in  Berne  under  conditions  which  are  particularly 
unfavorable  or  favorable,  whichever  one  may  have  a  mind  to 
call  them.  My  foreign  clientele  is  composed  only  of  patients 
who  have  been  ill  a  long  time,  and  who,  before  deciding  to 
seek  a  cure  in  another  country,  have  made  innumerable  at- 
tempts at  treatment  at  home.  Really,  I  must  say,  they  are  the 
best  of  the  nervous  patients  which  my  esteemed  foreign  con- 
freres send  to  me. 

Ah,  well,  in  the  last  twenty  years  I  have  had  to  treat 


»  C.  S.  Manto.    Sur  le  iraitement  de  thysUrie  <*  thdpital.    Thfese  de  Paris,  1899,  Stein- 
hcil.    (Observations  on  23  patients.) 


276  PSYCHIC  TREATMENT 

hundreds  of  cases  of  nervous  dyspepsia,  more  or  less  com- 
plicated with  other  nervous  troubles,  and  I  can  state  that 
nothing  is  easier  than  to  suppress  all  these  symptoms  in  a  few 
weeks.  In  consequence  this  part  of  the  treatment  has  not, 
for  the  last  ten  years,  interested  me  so  particularly;  it  has 
become  hackneyed  to  me. 

For  one  or  two  days  I  have  to  take  particular  care  to 
persuade  my  patient,  but  soon  I  no  longer  have  to  concern 
myself  with  his  gastric  troubles.  It  often  happens  that  my 
patients  pass  on  to  the  stage  of  overfeeding  without  knowing 
that  we  had  already  reached  the  seventh  day.  Formerly  that 
was  the  decisive  moment  for  me;  now  I  am  so  persuaded  be- 
forehand that  it  will  succeed  that  I  forgot  this  date,  and  if 
I  continue  the  daily  psychotherapeutic  conversations,  it  is  to 
act  on  the  mentality  of  the  patient  and  to  lead  him  to  a  sound 
philosophy  of  life. 

Like  Dejerine,  I  have  been  struck  by  the  great  inconve- 
niences of  the  diagnostic  researches  of  gastro-therapeutics. 
Far  be  it  from  me  to  wish  to  repudiate  these  methods  of 
diagnosis;  on  the  contrary,  we  ought  to  make  every  effort  to 
refine  our  methods  of  examination.  But  there  is  an  abyss 
between  these  psysiological  experiments  made  on  the  man 
and  clinical  experience;  our  modern  chemists  leap  lightly 
over  it;  alas!  it  is  not  they  who  break  their  heads,  it  is  the 
poor  patients. 

The  diagnosis  by  exploration,  trial  breakfasts,  and  chem- 
ical tests,  ought  to  be  reserved  for  the  rare  cases  where  there 
is  reason  for  hesitating  in  diagnosis  between  nervousness  and 
organic  affections.  To  apply  them  to  nearly  every  case  of 
dyspepsia  is  merely  to  throw  dust  in  the  patient's  eyes  by 
giving  him  the  illusion  of  having  been  well  examined — I  have 
detected  many  gastro-therapeutists  in  this  state  of  mind  which, 
perhaps  unconsciously,  is  common  to  many  specialists — or 
else  to  make  useless  scientific  tests  from  which  the  patient 
often  suffers. 

Yes,  the  art  of  diagnosis  is  very  refined,  and  I  have  been  too 
long  in  the  hospitals  to  have  lost  the  love  of  precision;  but 
there  are  many  cases  where  this  examination  into  details 


OF   NERVOUS   DISORDERS          277 

shows  merely  a  frankly  selfish  scientific  curiosity  on  the  part 
of  the  worker  rather  than  a  lively  sympathy  for  the  patient. 

There  are  times  when  one  must  know  how  to  shut  one's 
eyes  not  to  be  on  the  lookout  for  danger.  There  is  a  certain 
cruelty  in  wanting  at  all  hazards  to  make  a  precise  diagnosis 
of  tuberculosis,  cancer,  or  serious  affections  in  general.  We 
must  pay  attention  to  them;  even  when  we  are  silent  and  try 
to  deceive  the  patient  by  giving  her  assurances  of  cure,  we 
betray  ourselves  by  a  mania  of  wanting  to  employ  all  the 
methods  of  research.  One  must  know  enough  to  dispense 
with  the  thermometer  when  the  presence  of  fever  disturbs 
the  patient,  and  with  your  search  for  bacilli  when  you  run 
the  risk  of  alarming  his  mind  by  them,  for  you  can  thus  do 
him  more  harm  than  good. 

The  physician  should  not  be  only  a  wise  man  who  prac- 
tises on  his  patient  a  sort  of  vivisection,  but  he  ought  to  be, 
before  all,  a  man  of  heart  who  knows  how  to  put  himself  in 
the  place  of  those  who  suffer. 

In  the  domain  of  nervousness  this  fallacious  precision  of 
diagnosis  is  dangerous.  I  have  said  that  the  idea  and  the 
mental  representation  play  an  important  role  in  the  genesis 
of  all  the  psychoneuroses,  and  the  physician  runs  a  great 
risk  of  confirming  the  hypochondriacal  condition  of  the  patient. 

The  physician  can  only  avoid  this  danger  by  developing 
these  qualities  of  the  observer  in  learning  to  judge  his  cases 
as  a  whole,  without  the  need  of  exhausting  all  methods  of 
research. 

"  One  can't  see  the  woods  for  the  trees,"  says  a  German 
proverb,  and  I  am  astonished  to  see  how  many  young  physi- 
cians possessing  all  the  working  machinery  of  diagnosis  do 
not  know  how  to  make  a  diagnosis. 

It  is  because  the  art  of  diagnosis  does  not  consist  merely 
in  gathering  together  a  great  many  facts,  but  in  coordinating 
those  that  one  has  been  able  to  collect,  in  order  to  reach  a 
clear  conception  of  the  situation.  Along  this  line  we  might 
say :  "  Observations  are  not  to  be  numbered,  but  weighed  " 
(Non  numerandae  sed  ponderandae  sunt  observationes). 


278  PSYCHIC  TREATMENT 


CHAPTER   XXII 

Influence  of  Mental  Representations  on  the  Intestine  —  Abuse  of  the 
Word  "Enteritis" — Emotional  Diarrhea — Necessity  of  Combating 
this  Psychic  Sensibility  —  Fixation  of  Thought  on  Intestinal  Trou- 
bles —  Its  Inconveniences  —  Physiological  Experiences  ;  Pavlow  and 
Kronecker — Mucomembranous  Colitis:  Its  Habitual  Cause,  Con- 
stipation 

THO  one  might  not  have  paid  particular  attention  to  the 
frequency  of  nervous  dyspepsias,  he  would  have  no  difficulty 
in  recognizing  that  emotions  and  mental  representations  can 
diminish  the  appetite,  cause  feelings  of  disgust,  and  disturb 
the  digestion.  Every  one  can  find  examples  of  such  influence 
in  his  own  life. 

It  seems,  however,  that  one  forgets  the  possibility  of 
these  reactions  in  considering  the  lower  portions  of  the  in- 
testinal canal.  Tho  subjected  to  the  control  of  the  will,  the 
intestinal  movements  seem  to  be  put  outside  the  pale  of  psy- 
chic influence.  This  is  an  error.  There  are  as  many  intestinal 
disorders  which  are  "  nervous  "  and  which  may  depend  on  the 
mental  state  as  there  are  dyspepsias. 

The  nervous  diarrheas  in  particular  are  very  frequent,  and 
physicians  are  wrong  when,  always  anxious  to  employ  tech- 
nical phrases,  they  call  them  enteritides. 

True  enteritis — that  is  to  say,  inflammation  of  the  intestinal 
mucous  membrane — is  a  rare  disease,  resulting  most  frequently 
from  chemical  or  microbic  intoxications.  It  is  often  attended 
by  fever,  as  is  the  case  with  the  majority  of  the  inflammations, 
and  the  clinical  picture  is  wholly  different  from  that  of  nervous 
diarrhea. 

Nevertheless,  my  clients  assure  me  every  day,  both  verbally 
and  by  letter,  that  they  are  afflicted  with  chronic  enteritis. 


OF  NERVOUS   DISORDERS         279 

This  enteritis,  like  dilatation  of  the  stomach  and  enteroptosis, 
is  the  fashion,  and  a  French  confrere  of  much  perspicacity 
once  said  smilingly  to  his  patient :  "  But,  madam,  every  self- 
respecting  person  to-day  has  dilatation  of  the  stomach  and 
enteritis !  "  And  it  is  to  combat  this  trouble  that  people  go 
to  drink  the  waters  every  year;  that  they  live  on  restricted 
diet,  eating  nothing  but  meat,  rice,  eggs,  and  vegetable  purees. 
It  is  for  this  that  they  irrigate  the  intestines  and  practise  intes- 
tinal antisepsis ! 

For  myself  I  can  not  accept  these  views.  I  will  leave  to 
the  specialists  in  children's  diseases  the  diarrheas  of  early  life, 
which  are  often  amenable  to  dietetic  measures,  altho  I  always 
feel  a  certain  just  distrust  of  the  physician  who  is  too  much 
imbued  with  his  power  and  who,  in  his  prescriptions,  departs 
too  far  from  an  ordinary  diet. 

I  would  treat  by  diet  and  medicines  the  various  acute  or 
chronic  diarrheas  which  are  due  to  some  local  affection  of  the 
intestine,  but  I  do  not  hesitate  to  say  that  the  majority  of  these 
so-called  enteritides  are  only  provoked  or  encouraged  by  ner- 
vousness, and  that  it  is  easy  to  cure  them  by  advice  which  has 
more  to  do  with  moral  than  with  physical  hygiene. 

Nothing  is  more  frequent  than  emotional  diarrhea:  that 
of  soldiers  on  the  field  of  battle,  of  children  who  are  fright- 
ened, and  of  ladies  who  are  excited  at  the  prospect  of  a 
journey  or  some  social  obligation  that  is  slightly  disturbing. 
By  its  frequent  repetition  this  emotional  reaction  becomes 
easier,  as  in  an  erethrophobia  in  which  the  slightest  psychic 
action  drives  the  blood  to  the  face,  so  much  so  that  the  patient 
blushes  at  everything  and  nothing. 

What  can  one  do  to  overcome  such  sensitiveness  and  to 
suppress  this  excessive  reaction  ?  Shall  we  prescribe  opium  or 
tannin?  No!  These  means  more  frequently  only  give  pal- 
liative results  when  they  do  not  produce  diametrically  opposite 
effects  to  those  that  are  expected.  One  must  lessen  the  emo- 
tional tendency.  It  is  necessary  for  the  patient  to  understand 
the  inconveniences  of  this  psychic  hyperesthesia  and  to  make 
every  effort  to  regard  with  great  indifference  and  calm  reason- 
ing the  events  which  have  the  power  to  disturb  him.  One 


280 

can  bring  patients  to  this  state  of  mind  by  analyzing  the 
situation  with  them,  by  teaching  them  to  judge  wisely  and 
to  arm  themselves  with  logical  reasons  to  diminish  this  reaction 
which  takes  place  too  readily.  It  is  necessary  for  the  patient 
to  understand  how  much  the  attention,  fixed  on  an  organic 
phenomenon  even  independent  of  the  will,  can  favor  its  pro- 
duction, that  they  may  be  inspired  with  all  possible  interest  in 
diminishing  the  frequency  of  the  reaction. 

This  idea  must  be  fixed  in  their  understanding  by  imagery. 
I  have  been  accustomed  to  compare  these  reactions  to  the 
action  of  a  bolt  which  runs  the  more  easily  the  more  it  is  used, 
and  which  rusts  if  it  remains  too  long  immovable.  The  pa- 
tient then  understands  the  possibility  of  little  by  little  lessening 
the  emotional  and  psychic  action,  and  by  this  means  the  re- 
action which  it  has  on  the  organism. 

The  task  is  often  difficult,  but  it  is  always  possible  when 
the  physician  knows  how  to  find  just  arguments,  and  to  fit 
his  conversation  to  the  psychology  of  the  subject.  In  many 
cases  the  patient's  emotional  tendency  is  so  perceptible,  and  he 
points  out  so  clearly  the  psychic  influence  which  determines 
the  intestinal  flux,  that  it  is  easy  to  make  a  diagnosis  of 
nervous  diarrhea.  But  there  are  rarer  cases  in  which  it  is 
difficult  to  differentiate  the  psychic  influence. 

I  will  quote  an  example.  A  man  fifty-eight  years  of  age 
consulted  me  for  a  chronic  diarrhea  which  had  resisted  all 
the  medications  of  a  confrere  who  was  as  expert  as  he  was 
prudent  in  his  treatment.  The  latter  had  done  so  well  that 
he  embarrassed  me  by  sending  me  the  patient;  he  left  me  no 
possible  weapon  which  he  had  not  already  employed  without 
success.  On  the  first  examination  I  did  not  detect  any  ap- 
parent symptom  of  nervousness  in  the  patient,  except,  perhaps, 
a  slight  sensitiveness,  and  a  manner  of  complaining  with  tears 
in  his  eyes. 

Thinking  that  there  might  be  intestinal  catarrh,  perhaps 
even  a  neoplasm,  I  had  recourse  to  diet  and  medication.  Dis- 
couraged by  my  lack  of  success,  I  put  the  patient  upon  a 
copious  and  varied  diet,  a  measure  which  had  often  succeeded 
for  me  in  enteritis,  even  when  of  tuberculous  origin.  But  the 


OF  NERVOUS   DISORDERS         281 

diarrhea  only  increased  every  day,  and  I  no  longer  knew 
which  saint  to  invoke. 

Little  by  little  I  became  acquainted  with  the  mental  per- 
sonality of  the 'subject;  I  detected  hypochondriacal  tendencies 
and  his  inclination  to  think  only  of  himself,  and  one  day  I 
turned  on  him,  saying  in  a  kindly,  but  somewhat  crusty,  man- 
ner :  "  But,  my  dear  sir,  I  am  beginning  to  think  that  your 
diarrhea  which  arose  some  day  under  whatever  cause  it  may 
have  been  only  lasts  so  long  because  you  are  always  thinking 
of  your  intestines!  Will  you  please  try  to  forget  it,  and 
think  of  the  people  around  you  whose  existence  is  made  in- 
tolerable by  your  culinary  demands.  Your  wife  can  no  longer 
think  of  anything  to  cook  for  her  tyrant !  "  On  questioning 
the  patient  a  little  longer  he  acknowledged  to  me  that  he  talked 
constantly  of  his  diarrhea,  and  that  he  predicted  its  appear- 
ance to  his  wife  before  he  had  even  touched  the  dish  which 
she  had  prepared  for  him.  He  recognized  without  any  trouble 
the  role  which  his  preoccupations  had  played.  He  continued 
a  hearty  diet  which  led  to  regular  increase  of  weight,  and  the 
diarrhea  stopped  in  the  course  of  a  few  days.  The  patient 
was  cured  several  years  ago,  and  has  only  preserved  a  certain 
sensitiveness  of  the  intestines  to  certain  digressions  in  diet 
which  it  is  easy  for  him  to  avoid. 

More  often  nervous  diarrhea  is  accompanied  by  gastric 
dyspepsia,  anorexia,  eructations,  belchings,  flatulency,  and  dis- 
tinctly neurasthenic  symptoms,  such  as  headache  and  power- 
lessness  to  act.  These  patients,  when  kept  in  bed  and  on  a 
preparatory  milk  treatment,  stand  overfeeding  very  well.  I  note 
the  observation  which  follows,  which  has  been  summed  up  by 
the  patient  himself.  It  shows  how,  while  treating  intestinal 
troubles  by  measures  diametrically  opposed  to  the  customary 
prescriptions,  one  can  at  the  same  time  do  a  more  important 
work,  and  give  the  patient,  who  has  for  a  long  time  been  in  a 
helpless  state,  the  power  of  complete  and  definite  work. 

I  shall  leave  the  observation  in  the  summarized  form  as 
it  was  given  to  me  by  the  patient,  an  intelligent  young  man 
thirty-two  years  of  age,  who  summed  it  up  for  me  in  writing 
in  these  terms: 


282  PSYCHIC   TREATMENT 

"  Heredity  arthritic  and  nervous.  Mother  delicate  from 
the  birth  of  her  son. 

"  First  period — Up  to  sixteen  years  of  age,  health  good ; 
muscle  under-developed  in  the  trunk  and  arms ;  occasionally 
slight  intestinal  disturbance;  work  easy,  and  generally  carried 
on  with  too  much  zeal;  regular  exercise  sufficient. 

"  Second  period — From  sixteen  to  twenty-three  years,  ap- 
pearance of  neurasthenia  under  the  form  of  headache  in  social 
gatherings  where  the  air  was  close ;  excessive  fear  of  heat ; 
work  sometimes  not  very  lucid;  excessive  emotions;  failed  to 
pass  an  examination  on  this  account,  altho  well  prepared. 

"  This  neurasthenia  is  attributable  to  excessive  intensity  of 
thought,  which  was  much  too  prolonged,  and  also  to  some 
physical  fatigue  while  climbing  in  the  Alps;  passed  examina- 
tions with  success  in  spite  of  this  nervous  fatigue ;  underwent  a 
year  of  military  service  without  any  apparent  symptoms  of 
neurasthenia. 

"  The  undertaking  of  still  more  serious  studies,  and  proba- 
bly the  influence  of  life  without  a  family,  and  taking  meals 
at  a  restaurant,  brought  on  intestinal  troubles,  with  atony 
and  constipation  alternating  with  diarrhea.  The  patient  took, 
thereupon,  local  treatment  by  saline  enemas  charged  with 
electricity;  but,  far  from  improving  the  condition,  this  treat- 
ment only  irritated  the  intestine.  Then  followed  a  restricted 
diet,  prescribed  by  a  celebrated  specialist,  which  resulted  dis- 
astrously. 

"  Having  undertaken  new  examinations  with  success,  the 
patient  recovered  his  elasticity  of  spirit,  and  experienced 
marked  improvement;  he  took  hydrotherapy,  and  the  physi- 
cians ordered  abandonment  of  studies  on  the  ground  that 
any  intensity  of  thought  could  not  be  endured. 

"  Third  period — From  twenty-three  to  thirty  the  patient 
took  up  painting  to  kill  time,  but  was  obliged  to  give  it  up 
on  account  of  nervous  fatigue;  led  a  desultory  life  without 
regular  occupation ;  made  trials  of  arsenical  treatment  at  home ; 
used  glycerophosphates,  etc.,  without  the  slightest  success;  at 
times  had  serious  intestinal  troubles  with  atony  and  an  occa- 
sional clearing  out  of  the  intestines.  No  gastric  dyspepsia 


OF   NERVOUS    DISORDERS          283 

appeared,  but  there  were  variations  of  weight  between  one 
hundred  and  fifty-three  and  one  hundred  and  forty  pounds 
(without  clothes),  one  hundred  and  fifty-three  pounds  having 
been  the  maximum  weight  throughout  life.  At  twenty-five 
years  the  patient  had  had  pleurisy,  without  effusion  or  fever. 

"  Married  at  twenty-six  years  of  age,  the  patient  continued 
this  desultory  life.  At  twenty-nine  years  of  age,  after  exces- 
sive fatigue  and  poor  nourishment  in  an  officer's  position  in 
the  Alps,  he  became  seriously  run  down,  with  an  appearance 
of  gastric  dyspepsia;  work  became  more  or  less  difficult,  and 
the  patient  was  often  not  very  lucid. 

"  Fourth  period — From  thirty  to  thirty-two  years.  In 
May,  1896,  the  patient,  by  the  formal  advice  of  the  physician, 
had  given  up  all  work,  and  little  by  little  had  stopped  reading. 
He  sojourned  in  a  high  altitude,  which,  on  account  of  the  hotel 
food,  considerably  aggravated  the  gastric  condition.  There 
was  rapid  decline  of  strength,  which  neither  raw  meat  nor 
injections  of  serum  could  moderate.  In  the  winter  of  1896- 
1897  a  second  slight  attack  of  pleurisy  occurred.  He  took 
the  rest  cure,  with  small  meals  of  raw  meat  (one-half  pound 
per  day),  and  a  farinacious  diet,  without  vegetables.  There  was 
aggravation  of  the  general  condition,  and  the  weight  fell  to 
one  hundred  and  thirty-three  pounds.  The  impossibility  of 
following  any  occupation  whatsoever  occurred,  with  complete 
exhaustion  after  a  short  visit  to  a  friend.  Injections  of  various 
serums  were  tried  without  success.  The  tongue  was  white, 
the  patient  being  continually  nauseated.  There  was  consti- 
pation with  evacuations  of  membrane  and  sharp  pains  in  the 
colon.  Acute  putrid  diarrhea  followed,  which  was  attributed 
to  the  digestion  of  spoiled  meat;  bloody  stools;  severe  intesti- 
nal desquamation,  and  extreme  emaciation.  Unsuccessful 
treatment  followed  by  benzo-naphthol,  bitters,  koumiss,  and 
intestinal  irrigations.  However,  on  giving  up  all  this,  the  dis- 
order was  reduced  to  a  better  condition  in  the  summer  of  1897, 
the  patient  able  to  resume  walking,  and  standing  it  for  two 
or  three  hours  per  day,  the  weight  having  increased  to  one 
hundred  and  forty  pounds.  He  recovered  his  gaity  and  so- 
ciability, but  reading  was  still  impossible. 


284  PSYCHIC  TREATMENT 

"A  new  course  of  hydrotherapy  produced  an  aggravation 
from  the  start.  Following  the  treatment  came  improvement. 
The  weight  increased  slightly,  and  reading  produced  fatigue 
a  little  less.  The  gastric  digestion  was  fairly  good,  but  the 
regime  of  excluding  vegetables  and  raw  fruit  was  continued. 
Stools  were  much  better,  with  a  tendency  to  constipation, 
which  required  enemas.  During  the  winter  of  1897-1898  de- 
plorable treatment  in  a  hydrotherapeutic  establishment  was 
resorted  to,  with  aggravation  of  intestinal  troubles.  A  copi- 
ous diarrhea  followed  the  meals — frequent  stools,  sometimes 
twelve  to  fifteen  a  day,  and  often  evacuation  of  pure  mucus. 
Rest  for  a  month  in  the  south  was  taken  without  improvement. 
The  sleep,  which  had  been  excellent  heretofore,  was  now  dis- 
turbed ;  the  patient  often  stayed  awake  for  three  or  four  hours 
at  night." 

It  was  in  this  state  that  I  undertook  the  treatment.  The 
patient  weighed  at  that  time  one  hundred  and  thirty-three 
pounds ;  he  looked  very  badly,  with  rings  under  his  eyes.  His 
appetite  was  fair,  but  after  his  meals  he  had  belchings,  diarrhea, 
and  pains  throughout  the  abdomen.  After  having  learned  of 
his  condition  and  his  antecedents  I  was  able  to  say  to  my 
patient :  "  I  have  no  hesitation  in  telling  you  that  we  have 
here  no  signs  of  chronic  enteritis,  but  a  neurasthenic  condi- 
tion with  various  troubles:  physical  and  intellectual  fatiga- 
bility,  insomnia,  with  gastric  and  intestinal  troubles  that  are 
either  coexistent  or  alternate.  All  that  is  nervous.  Now 
there  have  been  nine  years  that,  like  a  June  bug  beating 
always  against  the  same  window,  you  have  been  trying  to 
cure  yourself  by  diet  and  medications  and  cold  water.  Now, 
do  you  not  think  that  the  time  has  come  to  start  out  in  a 
diametrically  different  direction  ?  " 

The  patient  replied :  "  That  is  precisely  what  I  have  said 
for  a  long  time.  Give  me  your  advice,  and  I  will  do  all  that 
you  wish." 

"  Very  well.  I  propose  to  you :  ( I )  Rest  in  bed  for  six 
weeks,  because  you  are  in  a  state  of  exhaustion.  There  is  no 
need  for  me  to  insist  in  order  to  make  you  understand  the 
value  of  such  economy  of  forces.  (2)  To  prepare  the  stomach 


OF  NERVOUS    DISORDERS          285 

you  are  going  to  go  upon  a  milk  diet  for  six  days,  then,  with- 
out the  least  fear,  you  will  take  three  regular  hearty  meals 
without  choosing  your  food,  and  you  will  drink  milk  between 
meals.  I  know,  as  you  can  well  see,  that  this  is  wholly  op- 
posed to  the  restricted  diet  that  you  have  lived  upon  for  so 
many  years  without  any  success,  and  that  you  have  obeyed 
with  a  conscientious  care  that  was  worthy  of  better  success. 
Your  food,  from  the  seventh  day  on,  will  be  so  abundant  that 
I  would  not  like  to  share  it  with  you.  I  have  a  good  stomach, 
but  I  can  not  stand  such  overfeeding.  In  order  to  keep  up 
with  you,  I  should  have  to  go  to  bed  and  take  a  milk  diet  for 
six  days :  then  there  would  be  a  pair  of  us !  " 

The  patient  bravely  undertook  the  task  without  worrying 
over  his  gastric  troubles  or  his  diarrhea ;  he  drank  his  milk  and 
in  the  second  week  was  able  to  take  such  an  abundance  of  food 
that  in  seven  days  he  gained  nine  pounds.  His  progress  con- 
tinued. The  diarrhea  diminished  little  by  little;  his  strength 
came  back,  and  at  the  end  of  fifty  days  his  weight  had  in- 
creased from  one  hundred  and  thirty-three  to  one  hundred 
and  sixty-two  pounds,  or  about  half  a  pound  a  day. 

At  the  end  of  the  second  week  the  improvement  in  the 
gastro-intestinal  troubles  was  so  evident  that  I  could  say: 
"  You  still  suffer,  I  know ;  but  as  far  as  your  so-called  enter- 
itis is  concerned,  we  are  perfectly  assured  of  the  future.  I 
am  so  sure  that  you  will  little  by  little  lose  all  these  troubles 
that  I  may  as  well  confess  to  you  that  I  am  not  very  much 
interested  in  this  secondary  question.  What  disturbs  me  about 
you  is  that  at  thirty  years  you  are  thus  living  a  life  of 
idleness,  without  work  and  without  regular  occupation.  It 
is  moral  health  that  you  need  first  of  all,  your  physical  health 
depends  on  it;  but  this  confidence  in  yourself  is  something 
that  you  can  never  acquire  by  douches,  benzo-naphthol,  and 
glycero-phosphates.  Forget  your  stomach  and  your  intes- 
tines; bear  bravely  the  discomforts,  which  the  functioning  of 
these  organs  still  cause  you,  and  try  to  get  into  your  heart 
the  ambition  to  lead  an  active  and  courageous  life." 

My  patient  looked  at  me  for  a  moment  in  astonishment, 
and  said :  "  What !  do  you  believe  that  I  could  ever  work 


286  PSYCHIC   TREATMENT 

again?  It  is  only  a  fortnight  since  my  physician,  who  knows 
me  well,  said  to  me :  '  My  dear  sir,  you  will  have  to  give  up 
trying  to  get  rid  of  this  enteritis;  it  is  of  too  long  standing; 
and  you  must  continue  for  the  rest  of  your  life  to  live  upon 
a  very  careful  diet;  it  is  not  so  distressing;  you  will  see,  one 
gets  accustomed  to  it!  As  to  work,  you  must  not  1:hink  of 
such  a  thing!  Your  capital  of  nervous  strength  will  not  al- 
low it.  You  can  only  occupy  yourself  a  little  for  your  amuse- 
ment, or  to  take  up  some  unimportant  thing.'  " 

I  replied :  "  Your  intestinal  troubles  will  surely  improve 
during  the  treatment  of  overfeeding.  You  are  going  to  gradu- 
ally get  stronger.  You  are  intelligent  and  have  a  taste  for 
work;  your  whole  state  of  helplessness  is  only  due  to  your 
conviction  of  helplessness,  and  I  advise  you  without  the  slight- 
est hesitation  to  go  back  to  an  active  life  after  your  treatment 
is  over." 

The  patient  was  quickly  persuaded,  and  in  spite  of  numer- 
ous discomforts  during  the  rest  of  the  treatment  he  was  able 
to  preserve  a  frankly  optimistic  disposition.  I  had  more  dif- 
ficulty in  convincing  the  patient's  friends  who,  more  fearful 
than  he,  made  every  effort  to  controvert  his  plans. 

On  his  return  home  the  patient  began  his  reading  and  his 
book- work  and  took  up  a  normal  life.  The  exercise  of  walk- 
ing was  for  a  long  time  difficult,  but  the  progress  was,  never- 
theless, continued.  A  fortnight  later  I  saw  the  patient  again 
and  improved,  having  kept  the  weight  of  one  hundred  and 
sixty-four  pounds  which  he  had  acquired.  He  is  not  yet 
quite  well,  as  the  following  note  shows: 

"  i.  Sleep  always  mediocre;  frequent  insomnia  of  two  or 
three  hours. 

"  2.  Movements  too  soft.  Pains  tolerably  well  borne,  espe- 
cially during  the  period  of  insomnia.  A  feeling  of  rectal  irrita- 
tion with  the  need  to  go  to  the  toilet  in  the  daytime.  These  last 
jymptoms  more  fugitive  and  generally  yielding  to  distraction. 
Appetite  often  cut  short  by  a  feeling  of  intestinal  irritation 
during  the  meal. 

"3.  Work  possible,  but  still  with  frequent  headaches." 

I  encouraged  the  patient  to  persist  and  to  continue  a  nor- 


OF  NERVOUS   DISORDERS         287 

mal  diet,  eating  heartily  enough  of  everything  so  as  not  to 
grow  thin,  and,  above  all,  I  urged  him  to  work. 

Ten  days  later  he  resumed  his  work.  There  was  rapid 
improvement  of  all  the  symptoms.  Since  then  he  has  not 
had  any  relapses.  From  time  to  time  the  patient  complains 
somewhat  of  some  intestinal  troubles :  flatulency  and  explosive 
diarrhea.  He  had  for  some  time  a  cough  that  was  a  little 
suspicious,  and  which  disturbed  me  on  account  of  his  having 
had  two  pleurisies.  That  was  another  very  strong  reason  for 
me  to  insist  upon  a  copious  and  varied  diet,  which  is  the  only 
truly  strengthening  one.  His  power  to  work  grew  steadily. 
He  could  occupy  a  scientific  position  which  offered,  and  his 
health  has  been  excellent  for  the  last  six  years.  To-day  he 
is  a  man  who  publishes  scientific  works  of  great  value,  who 
works  twelve  or  fourteen  hours  a  day,  and  at  the  same  time 
lives  a  social  life,  and  has  no  fear  even  for  the  polemics  of  the 
press,  which  are  irritating  to  any  one.  A  man  of  science  and 
a  philosopher,  he  lives  a  healthy  and  useful  life. 

This  observation  shows  how  gastro-intestinal  troubles, 
which  have  resisted  all  treatment  for  ten  years,  will  slowly 
but  surely  yield  to  a  strengthening  diet  of  overfeeding  fol- 
lowed by  a  normal  diet,  if  one  knows  how  to  dissipate  the 
fears  of  the  patient  and  to  convince  him  that  he  can  live  like 
other  people. 

It  also  shows  how  one  can  give  him  confidence  in  himself 
and  lead  him  back  to  an  active  life  without  even  taking  care 
to  avoid  overwork. 

Every  day,  moreover,  the  physicians  could  detect  in  their 
patients  this  influence  of  the  morale  on  the  functions  of  the 
intestinal  canal,  and  utilize  these  ideas  to  cure  them.  But 
they  act  on  them  in  just  the  opposite  sense;  they  make  a 
diagnosis  of  enteritis  without  seeking  the  causes  which  have 
produced  the  intestinal  trouble;  they  teach  them  to  shrink 
back  from  obstacles  instead  of  meeting  them  openly;  they 
condemn  them  to  a  life  of  idleness,  which  encourages  the 
hypochondriacal  mentality  common  to  nearly  all  the  neuroses. 

It  must  be  admitted  that  physiology,  such  as  we  have  been 
taught  until  now,  does  not  open  our  eyes  to  these  relations 


288  PSYCHIC  TREATMENT 

of  the  physical  and  the  moral.  However,  the  dawn  has  come 
in  this  domain  of  exact  experimental  science. 

In  an  authoritative  work  on  the  functions  of  the  digestive 
glands  Pavlow,  of  St.  Petersburg,1  has  shown  that  in  the  dog 
the  secretion  of  gastric  juice  is  not  stimulated,  as  had  hitherto 
been  believed,  by  the  mechanical  and  chemical  irritation  of 
the  gastric  membrane,  but  that  it  is  caused,  first  of  all,  by 
desire,  or  by  mental  representation.  The  psychic  appetite  is 
the  most  powerful  stimulus  to  the  digestive  functions.  A  dog 
who  is  made  to  hope  for  the  treat  of  a  piece  of  meat  by  show- 
ing him  the  plate  secretes  the  same  quantity  of  gastric  juice 
as  another  to  whom  three  or  four  ounces  of  meat  was  given 
to  chew. 

The  ignorance  of  this  psychic  influence  has  led  the  physi- 
ologist into  erroneous  conclusions.  Tickling,  through  a  fis- 
tula, the  mucous  membrane  of  the  stomach  with  the  end  of 
a  feather  or  a  glass  rod,  they  have  been  able  to  make  the  gastric 
juice  well  forth,  and  have  thus  thought  to  prove  that  mechan- 
ical irritation  was  enough.  This  reaction  would  not  have  been 
produced  if  the  operator  had  washed  his  hands,  so  that  there 
were  no  odors  of  food  on  them  capable  of  exciting  the  desire 
of  the  animal. 

Pavlow  has  also  shown  that  the  secretions  of  the  stomach 
and  the  upper  part  of  the  intestine  vary  in  their  chemical  com- 
position according  to  the  nature  of  the  food  introduced  into 
the  mouth,  even  when  one  avoids,  by  section  of  the  esophagus, 
the  entrance  of  food  into  the  stomach. 

By  a  nervous  path  the  digestive  glands  are  warned  of  the 
arrival  of  food,  and  prepare  in  advance  the  suitable  digestants 
for  the  albumenoids  and  fats. 

These  statements  confirm  the  clinical  facts  which  I  have 
hitherto  observed.  The  best  diet  is  a  varied  one;  that  which 
suits  healthy  people  as  well.  A  one-sided  diet,  whatever  it 
may  be,  has  its  drawbacks  in  drying  up  the  secretions  through 
lack  of  use;  and  if  the  quantity  of  the  prescribed  food  be- 
comes too  great,  it  exhausts  the  secretions  which  are  useful. 


»  The  Work  tfthe  Intestinal  Glands.    English  translation,  1902. 


OF  NERVOUS   DISORDERS         289 

In  order  to  make  the  organs  work  one  must  lead  them  along 
and  encourage  their  activity.  I  have  obeyed  this  very  simple 
therapeutic  principle  and  have  never  had  occasion  to  repent 
of  it. 

Another  physiologist,  Professor  Kronecker  of  Berne, 
summed  up  before  an  audience  of  physicians  one  day  his  ex- 
periments on  the  peristaltic  movements  of  the  dog,  studied 
by  means  of  a  silver  ball  introduced  into  an  intestinal  loop, 
isolated  by  Villa's  method.  The  rapidity  with  which  the 
ball  reached  the  end  of  the  isolated  loop  gave  the  measure 
of  the  rapidity  of  the  intestinal  movement.  He  noted  the 
acceleration,  which,  however,  was  inconstant,  provoked  by  the 
taking  of  food,  and  recalled  the  well-known  fact  of  belchings 
in  fasting;  he  indicated  the  acceleration  by  the  movement  and 
the  action  of  massage  of  the  abdomen,  and  then  by  these 
words :  "  Now,  gentlemen,  the  thing  that  acts  chiefly  on  the 
intestine  of  the  dog  is  his  emotions,  whether  joyful  or  sad ;  it 
is  enough  to  threaten  an  animal  with  punishment  or  to  make 
him  hope  for  a  walk  with  his  master  to  see  the  silver  ball 
reach  the  orifice  more  rapidly  than  under  the  influence  of 
physical  agencies." 

If  mental  representations  are  enough  to  provoke  secretions 
and  accelerate  the  peristaltic  movement  in  a  dog,  must  not 
this  intervention  of  the  idea  be  still  more  powerful  in  man 
in  whom  the  psychic  life  is  so  much  more  rich  and  compli- 
cated? 

Does  this  mean  that  in  all  cases  where  one  recognizes 
nervous  influence  in  intestinal  troubles,  the  success  will  be 
assured  ?  No ;  there  are  cases,  but  they  are  exceptional,  where 
one  does  not  succeed  in  entirely  suppressing  this  sensitiveness 
and  the  reaction  which  comes  too  easily.  I  have,  however, 
always  obtained  improvement ;  but  there  are  some  people  who 
are  so  constituted  that  they  develop  a  diarrhea  under  the 
influence  of  the  slightest  chill,  at  the  change  of  the  seasons. 
Such  patients  are  also  sensitive  to  variations  of  diet,  or  else 
preserve  some  idiosyncrasy  in  respect  to  raw  food.  It  is  by 
regulating  their  life  and  making  them  strong  in  body  and  in 
spirit  that  one  can  improve  their  condition.  There  is  a  form 


290  PSYCHIC  TREATMENT 

of  enteritis  concerning  which  I  should  insist,  and  that  is  one 
in  which  intestinal  clearing  out  alternates  with  constipation, 
or  one  in  which  scanty  stools  are  accompanied  by  mucous 
secretions.  It  is  a  paradoxical  diarrhea  which  can  exist  with 
a  constipation  that  produces  it.  I  have  seen  hemorrhoids  act 
in  the  same  way  following  the  introduction  of  some  foreign 
body,  such  as  a  suppository. 

This  functional  trouble  is  often  accompanied  by  tenesmus 
all  along  the  descending  colon.  The  evacuations  are  com- 
posed almost  entirely  of  mucus.  There  is  in  the  rectum  a 
hypersecretion  of  mucus  analagous  to  that  which  is  produced 
so  abundantly  in  the  esophagus  in  the  presence  of  a  sound. 

These  are  conditions  which  are  dignified  by  the  terms  "  en- 
teritis," "colitis,"  or  "pseudomembranous  proctitis,"  and  which 
are  treated  by  dietetic  prescriptions,  which  have  no  action  on 
the  lower  end  of  the  intestines,  or  by  medicated  enemata,  which 
only  aggravate  the  trouble. 

I  have  nothing  against  the  names,  altho  I  do  not  see 
the  utility  of  repeating  in  Greek  what  the  patient  tells  us  in 
his  mother  tongue.  It  is  not  enough  to  prove  the  presence 
of  the  disorder;  one  must  find  the  cause  and  bring  it  to  an 
end. 

Therefore  it  is  the  constipation  which  I  blame.  With  the 
exception  of  a  few  cases  of  intestinal  polypi  or  dysenteric 
affections,  I  have  never  seen  idiopathic  muco-membranous 
colitis.  I  have  always  seen  it  as  the  result  of  irregularities 
in  the  functioning  of  the  intestine,  and  in  particular  as  the 
result  of  habitual  constipation.  It  is  by  treating  this  latter 
that  one  can  get  rid  of  the  symptoms  of  rectal  irritation. 


OF  NERVOUS   DISORDERS         291 


CHAPTER   XXIII 

Habitual  Constipation — Uselessness  of  Laxatives — Efficacy  of  Treatment 
by  Training — Influence  of  Habit— Outline  of  Prescriptions  Intended 
to  Reestablish  the  Intestinal  Function — Suggestive  Influence — Psy- 
chology of  Constipated  Patients 

WISE  practitioners  of  all  times  have  counseled  keeping  the 
bowels  open.  And  the  public  seem  to  have  taken  this  pre- 
scription very  seriously.  Naturally  conservative,  they  cling 
to  old  ideas  and  one  sees  to-day  a  great  many  people  purging 
themselves  regularly  just  as  they  used  to  bleed  themselves 
fifty  years  ago.  Purgative  preparations  enjoy  a  great  vogue, 
chiefly  those  which  are  laxative  in  effect,  and  which  are 
thought  to  purify  the  blood. 

Modern  medicine  has  been  inclined  to  renounce,  and  per- 
haps wrongly,  evacuants,  emetics,  and  purgatives.  The  need 
of  making  an  attack  on  the  intestine  and  of  thus  combating 
divers  inflammations  is  not  so  often  felt,  but  still  we  often 
have  recourse  to  such  preparations  to  overcome  a  common 
functional  disturbance — namely,  habitual  constipation. 

One  has  only  to  glance  at  the  advertising  pages  of  our 
periodicals  to  see  how  much  these  remedies  are  still  used,  for 
the  supply  is  always  equal  to  the  demand.  In  short,  consti- 
pation is  an  evil  which  of  itself  may  lead  to  serious  disorders, 
and  which  complicates  the  situation  in  various  local  and 
general  affections.  It  is  seldom  that  simple  costiveness  causes 
serious  symptoms,  and,  since  the  role  of  the  appendix  has  been 
demonstrated,  one  seldom  hears  of  typhlitis  stercoralis.  How- 
ever, one  often  sees,  even  in  the  absence  of  intestinal  lesions, 
such  repletion  of  the  large  intestine  that  one  is  obliged  to 
resort  to  enemas  and  laxatives,  and  sometimes  even  to  manual 
extraction  of  the  feces. 


292  PSYCHIC  TREATMENT 

Constipation  is  aggravated  in  women  by  inflammation  of 
the  uterus  and  its  appendages;  it  is  made  worse  by  rectal 
distention  for  examination  and  gynecological  treatment.  In 
childbirth  it  often  produces  an  access  of  fever  which  a  purga- 
tive will  eliminate.  And,  finally,  in  the  course  of  feverish 
affections  of  any  of  the  organs,  it  raises  the  temperature  and 
increases  the  dyspnea.  In  all  such  cases  the  temporary  con- 
stipation the  treatment  is  formal.  One  must  get  a  prompt 
evacuation,  and  nothing  is  more  simple  and  efficacious  than 
an  enema  or  a  purgative. 

But  the  situation  is  by  no  means  the  same  in  chronic  con- 
stipation. In  1886 1  I  published  my  ideas  on  the  treatment 
of  this  functional  trouble;  I  will  return  to  it  in  some  detail, 
for  the  question  presents  a  practical  as  well  as  a  theoretic 
interest.  The  method  which  I  prescribed  gives  constant  ef- 
fects, and  throws  a  new  light  on  the  influence  of  ideas  on  our 
lower  functions. 

At  the  beginning  of  my  practise  I  did  as  other  do,  and 
prescribed  various  laxatives  for  constipation.  I  gave  the 
preference  to  preparations  of  aloes  which,  taken  in  the  even- 
ing, led,  without  pain  or  discomfort,  to  a  normal  morning 
evacuation.  For  a  certain  time  I  was  quite  as  satisfied  as 
my  patients  with  the  result  obtained,  but  my  joy  was  not  to 
last  long. 

Little  by  little  my  patients  came  back  to  me.  One  said: 
"  Your  pills  do  not  act  as  well  as  they  did ;  I  have  to  take 
two  or  three  of  them ;  it  seems  to  me  that  the  intestine  has  be- 
come accustomed  to  them  and  will  no  longer  respond."  An- 
other said :  "  They  alwdys  have  the  same  effect,  but  I  do  not 
want  to  be  obliged  to  take  pills  forever,  and  when  I  stop  I 
am  more  constipated  than  ever." 

I  then  tried  various  laxatives  which  the  pharmacists 
recommended  as  sovereign  and  exempt  from  all  inconvenience ; 
but  I  have  always  experienced  the  same  results:  very  prompt 
action  at  the  start,  but  inefficacy  in  the  long  run. 

I  therefore  took  a  decided  stand  and  gave  up  such  reme- 


1  Corrapondentbfatt far  Schweiter  Atrzte,  No.  1, 1886. 


OF  NERVOUS   DISORDERS         293 

dies  altogether,  and  instituted  a  method  of  rational  treatment 
by  using  the  tendency  to  a  regular  habit,  which  is  seen  in  all 
our  physiological  workings,  and  by  prescribing  some  rules  of 
diet. 

The  need  of  defecation  is  normally  established  by  the 
accumulation  of  feces  in  the  rectum,  just  as  appetite  is  cre- 
ated by  a  certain  degree  of  inanition  or  as  sleep  follows  fatigue. 
One  would  make  a  great  mistake  not  to  consider  these  normal 
physiological  stimuli.  All  our  functions  are  regulated  by 
habit.  We  often  have  an  appetite  at  the  hour  for  dinner, 
even  when  we  have  not  spent  our  strength  or  exhausted  our 
capital,  and  even  when  we  have  taken  food  a  few  hours  be- 
fore. Our  eyelids  grow  heavy  at  the  time  when  we  habitually 
go  to  bed,  even  though  we  have  displayed  no  particular  ac- 
tivity during  the  daytime;  and  when  we  are  accustomed  to 
going  to  bed  late,  we  can  not  go  to  sleep,  altho  by  reason  of 
hard  physical  or  mental  work  we  may  be  so  tired  that  we 
are  ready  to  say :  "  I  can  do  no  more." 

I  have  seen  persons  whose  evacuations  were  formerly  very 
regular  bring  obstinate  constipation  upon  themselves  by  a  poor 
choice  of  the  time  devoted  to  this  function.  It  was  at  an  hour 
when  the  person  was  occupied  and  sometimes  could  not  obey 
the  call.  The  next  day  the  need  was  felt  at  the  same  hour, 
and  again  the  person  resisted  it.  Later  the  intestine,  whose 
warnings  were  neglected,  felt  the  need  less.  The  bonds  of 
habit  had  been  broken  and  constipation  was  established.  I 
therefore  thought  of  using  this  tendency  of  habit  and  of  con- 
centrating in  the  morning  hours  all  the  stimuli  which  could 
act  upon  the  intestine. 

I  chose  the  morning  because  it  is  the  time  when  we  are 
freer  to  attend  to  these  hygienic  cares,  and  because  normally, 
during  the  long  night,  the  slow  movement  of  the  intestine  has 
brought  to  the  rectum  all  the  waste  products  of  our  food. 
There  is,  therefore,  in  the  morning  an  early  invitation  to  go 
to  the  toilet  which  arises  from  the  very  accumulation  of 
material. 

The  act  of  waking  in  itself  constitutes  a  second  stimulus. 
I  know  a  number  of  people  for  whom  the  awakening  of  peris- 


294  PSYCHIC   TREATMENT 

taltic  movements  follows  the  waking  of  their  person.  It  is 
inconvenient,  for  they  are  obliged  to  immediately  obey,  and 
to  jump  out  of  the  bed  in  which  they  were  so  comfortable. 

The  act  of  getting  up  with  the  movements  of  the  body 
which  are  caused  by  one's  toilet,  the  movement  of  putting  on 
one's  stockings  and  of  getting  into  one's  trousers  has  an  effect 
like  massage,  which  is  so  efficacious  that  I  have  had  some 
people  complain  that  they  can  not  forego  the  need  after  having 
laced  their  first  shoe. 

Here  are  three  invitations  which  follow  one  after  the 
other,  and  which  become  habitual,  especially  if  the  time  for 
rising  follows  the  waking  at  a  fixed  time. 

To  take  a  glass  of  cold  water  on  getting  up  is  a  measure 
which  has  often  been  recommended.  Entering  a  stomach  which 
has  been  empty  since  the  evening  before,  the  water  stimulates 
the  movement  of  the  stomach,  and  the  contraction  extends 
throughout  the  intestine;  this  is  a  fourth  stimulus.  If  the 
patient  has  noticed  that  warm  or  hot  water  succeeds  better 
I  do  not  insist  on  the  cold  water.  If  the  patient  is  a  smoker 
who  has  felt  the  good  effects  of  a  cigarette  I  permit  him  to 
use  it. 

The  eating  of  breakfast,  especially  if  it  is  quite  hearty, 
and  consists  in  part  of  bread  and  butter,  particularly  whole 
wheat  or  graham  bread,  also  stimulates  peristaltic  movements. 
Honey  may  be  a  useful  adjunct  when  a  person  can  take  it. 

At  this  point  one  must  establish  the  formation  of  the 
habit  of  going  at  a  fixed  hour  by  prescribing  regular  training. 
Let  the  patient  go  to  the  toilet  an  hour  after  the  beginning 
of  his  breakfast  and  you  will  thus  have  caused  six  successive 
invitations  to  act  upon  the  intestine,  any  one  of  which  would 
have  been  enough  for  a  subject  who  was  not  constipated,  but 
a  regular  succession  can  alone  overcome  the  intestinal  apathy 
of  your  patient.  The  will  has,  in  fact,  considerable  effect  on 
defecation.  The  voluntary  bringing  into  play  of  the  abdomi- 
nal pressure  displaces  the  fecal  masses,  irritates  the  anal  re- 
gion, and  induces  the  rectal  peristaltic  movement. 

In  short,  the  patient  must  be  coaxed  to  take  a  hearty  diet, 
and  reminded  of  the  adage:  Large  eaters  are  never  consti- 


OF  NERVOUS   DISORDERS         295 

pated.  His  attention  may  be  called  also  to  the  laxative  effects 
of  a  vegetable  diet  and  fruits  (the  herbivora  are  scarcely  ever 
subject  to  constipation),  and  one  will  have  instituted  a  phy- 
siological treatment  of  constipation  which  will  be  found  much 
more  efficacious  than  all  artificial  means. 

From  the  point  of  view  of  diet,  the  peasant  and  the  work- 
man, when  they  are  not  actually  poverty-stricken,  are  better 
nourished  than  the  people  of  the  upper  classes.  Obliged  to  be 
satisfied  with  vegetables  of  little  nutritive  value,  they  are  led 
to  eat  more  in  order  to  be  nourished  and  have  a  satisfied  feel- 
ing. Their  intestine  contains  much  waste  food.  Thus,  a  man 
of  the  people  generally  escapes  constipation,  obesity,  and  gout. 
The  rich  man,  on  the  other  hand,  often  eats  three  times  too 
much,  and,  giving  the  preference  to  very  nourishing  and  easily 
digestible  foods,  he  becomes  constipated,  fat,  and  gouty,  and, 
in  addition  to  all,  has  the  blues. 

Physicians  who  prescribe  a  restricted  diet  for  dyspeptics, 
forbidding  them  to  eat  vegetables  and  raw  things,  encourage 
the  laziness  of  the  intestinal  canal  as  much  as  they  can.  Then, 
obliged  to  have  recourse  to  enemas  of  water,  or  glycerine,  or 
medications,  or  to  the  electrization  of  the  intestine,  they  irri- 
tate these  organs,  and  it  is  often  to  such  ill-timed  interventions 
that  muco-membranous  colitis  is  due,  which  they  are  obliged 
to  cure  later  with  astringent  enemas. 

This  physiological  method  of  intestinal  treatment  always 
succeeds  in  ordinary  uncomplicated  cases  of  chronic  constipa- 
tion, however  protracted  they  may  have  been.  Painful  hemor- 
rhoids may  also  indicate  preliminary  treatment,  but  if  the  pain 
is  bearable  the  suppression  of  the  constipation  can  lead  to  the 
cure  of  this  complication. 

I  would  dare  say  that  the  cure  of  constipation  is  certain 
if  one  uses  these  means,  but  if  this  treatment  is  to  be  efficacious 
it  must  be  prescribed  with  entire  conviction.  This  I  insist 
upon,  and  to  those  who  want  to  make  the  attempt  I  will  give 
the  following  advice:  (i)  Draw  the  patient's  attention  to 
the  inconveniences  of  laxatives  and  enemas;  prohibit  them 
altogether;  burn  your  bridges  without  fear.  (2)  State  that 
one  always  succeeds  by  this  intelligent  treatment.  If  you 


296  PSYCHIC  TREATMENT 

have  already  had  some  success  along  such  lines  in  your  prac- 
tise, describe  them  with  convincing  eloquence.  (3)  Ask  your 
patient  when  he  gets  up  and  takes  his  breakfast.  You  can, 
to  a  certain  degree,  take  his  habits  into  account.  If  he 
gets  up  at  half  past  seven,  for  example,  give  him  the  fol- 
lowing prescription  in  writing:  (a)  7:30  A.M. — Rise,  (b) 
7:45  A.M. — Drink  a  glass  of  cold  water.  For  those  who  have 
a  superstitious  reverence  for  medication,  give  an  infusion  of 
quassia  prepared  the  evening  before,  (c)  8  A.M. — Hearty 
breakfast,  with  milk,  coffee,  or  tea,  according  to  choice,  and 
even  chocolate  for  those  who  are  not  constipated  by  this  food. 
Use  bread  (graham  if  possible)  and  butter,  with  honey  or 
preserves,  (d)  9  A.M. — Try  to  go  to  the  toilet  at  a  fixed 
hour.  Do  not  go  at  any  other  time,  and  refuse  to  do  so, 
saying  to  your  intestine :  "  You  would  not  move  at  nine 
o'clock:  now  you  can  wait  until  to-morrow!"  (e)  Use  a 
copious  diet,  giving  the  preference  to  vegetable  foods. 

But  do  not  be  content  with  enumerating  these  measures 
and  putting  them  on  paper;  explain  them,  comment  upon 
them,  and  enumerate  the  "  invitations  "  which  the  prescrip- 
tions contain.  The  patient  will  reply  to  you :  "  But  I  have 
already  tried  to  go  at  a  fixed  hour.  I  have  already  taken  a 
glass  of  cold  water."  You  can  reply  to  him :  "  My  dear  sir, 
six  cannons  can  make  a  breach  where  one  or  two  are  not 
enough.  Go  on  bravely  and  you  will  succeed ! " 

And,  last  of  all,  do  not  suppress  the  suggestive  effect  which 
you  have  just  produced.  An  excellent  confrere  who  for  long 
years  practised  this  treatment,  told  me  that  he  was  well  satis- 
fied with  it,  but  that  he  had,  nevertheless,  had  some  failures. 
Astonished  at  this,  I  made  him  go  over  the  prescriptions  which 
he  had  given.  They  were  as  complete  as  tho  I  had  dic- 
tated them  myself.  I  tried  to  find  the  cause  of  the  failure, 
when  my  confrere  added :  "  However,  I  have  never  discour- 
aged the  patient,  and  I  have  told  him  if  this  does  not  work 
there  are  still  other  means !  "  This  counter-suggestion  was 
sufficient  to  explain  his  failures.  When  one  wishes  to  convince 
one  of  anything  it  does  not  do  to  suggest  the  idea  of  possible 
failure. 


OF  NERVOUS   DISORDERS          297 

During  the  first  years  the  treatment  which  I  had  insti- 
tuted gave  me  some  regular  successes;  but  they  were  too 
slow  to  convince  me  that  they  were  due  wholly  to  the  training 
which  created  an  intestinal  habit.  It  would  take  a  fortnight 
to  three  weeks  to  attain  a  result.  The  successes  were  there, 
however,  and  that  fact  gave  me  assurance.  I  dared  to  pre- 
dict a  cure  in  all  sincerity.  My  influence  grew,  and  soon  I 
saw  my  patients  cured  in  eight  days  or  five  days  or  three  days. 
Emboldened  by  this,  I  was  still  more  affirmative,  until  I  saw 
patients  regain  the  regularity  of  their  stools  on  the  day  after 
a  single  consultation !  Let  me  quote  a  few  examples :  Mme. 

H was  a  woman  of  good  constitution  in  excellent  health, 

but  she  had  suffered  for  six  years  from  a  stubborn  consti- 
pation. She  had  exhausted  all  laxatives,  enemas,  and  mas- 
sage. I  sent  her  my  prescriptions  by  writing.  They  were 
received  with  a  skeptical  smile  by  the  patient  and  her  hus- 
band. Happily  for  her,  I  no  longer  felt  myself  discounte- 
nanced by  such  an  attitude,  and  I  stoutly  held  to  my  saying 
that  success  would  surely  come.  At  the  end  of  five  days  the 
stools  were  easy  and  regular,  and  the  constipation  never  re- 
turned. 

A  confrere  sent  me  a  bottle  of  200  grams  of  a  liquid 
full  of  parings  that  resembled  onion  peelings.  A  microscopical 
examination  showed  that  they  were  composed  of  mucous 
concretions,  and  a  diagnosis  of  muco-membranous  colitis  was 
made.  Then  I  saw  the  patient.  She  was  an  extremely  nerv- 
ous person,  who  had  suffered  martyrdom  in  her  conjugal  life. 
She  slept  little,  ate  almost  nothing,  and  had  an  obstinate 
constipation  which  she  had  tried  to  overcome  by  enemas  and 
purgatives.  As  a  result  there  was  intense  irritation  of  the 
rectum,  and  a  colitis,  which  the  physician  attempted  to  com- 
bat by  medicated  enemas  of  bismuth  and  rhatany. 

I  did  not  hesitate  to  propose  the  immediate  cessation  of 
all  local  treatment.  Leaving  the  intestinal  disorder  out  of 
the  question  as  if  of  no  importance,  I  tried  to  overcome  the 
nervousness.  I  insisted  on  the  necessity  of  overfeeding,  and 
showed  the  advantages  of  this  latter  for  the  functioning  of 
the  large  intestine.  I  toned  up  the  patient's  morale. 


298 

Success  was  not  long  in  coming.  The  patient,  encouraged, 
put  my  advice  on  overfeeding  into  practise,  and  soon  felt 
much  stronger.  Her  stools  rapidly  became  easy  and  regular. 
The  colitis  disappeared,  and  the  patient,  whom  I  have  often 
seen  since,  has  never  had  a  return  of  the  same  trouble. 

A  few  years  later,  in  a  discussion  with  some  confreres, 
the  physician  who  had  cared  for  the  patient  broke  a  lance  in 
defense  of  my  treatment.  He  confessed  that  at  the  first  con- 
sultation he  was  afraid  that  I  had  lost  my  head  when  I  pro- 
posed to  give  up  all  local  treatment,  but  that  soon  he  was 
obliged  to  recognize  that  the  counsel  was  wise. 

Mme.  G was  a  young  woman  of  frail  constitution,  with 

a  suspicion  of  bronchial  trouble.  She  had  been  treated  for 
several  years  by  the  usual  means  for  a  gastro-intestinal 
dyspepsia  with  persistent  constipation.  She  had  just  been 
through  a  treatment,  as  distressing  as  it  was  inefficacious,  with 
a  physician  who  was  a  specialist  for  the  stomach.  Thus  she 
had  grown  thinner  and  thinner,  and  ran  the  risk  of  contract- 
ing consumption  by  reason  of  her  malnutrition. 

I  detected  in  the  patient  the  symptoms  of  an  exaggerated 
moral  impressionability,  phobias,  and  hypochondriacal  preoc- 
cupations. I  prescribed  for  her  my  treatment  for  constipa- 
tion, and,  without  concerning  myself  more  with  the  symptoms, 
I  pursued  the  treatment  of  the  mind  in  daily  conversations. 

At  the  end  of  three  days  the  stools  were  regular,  the 
weight  of  the  body  had  increased,  the  intelligent  patient  be- 
came stoically  philosophical  and  went  away  cured.  Imbued 
with  the  principles  of  the  treatment,  she  was  a  help  to  all 
about  her,  bringing  her  friends  into  a  healthy  way  of  living. 

A  brother  physician  sent  me  his  wife  who,  for  six  years, 
had  suffered  from  constipation,  for  which  she  had  used  every 
kind  of  remedy  without  success.  I  saw  the  patient  at  eight 
o'clock  on  the  evening  of  her  arrival  and  prescribed  for  her 
the  treatment  of  training.  The  next  day  she  had  her  first 
spontaneous  stool.  During  the  three  weeks  that  she  spent 
with  me  she  had  no  constipation,  and  she  returned  cured. 
A  year  later  my  confrere  wrote  to  me  that  the  result  had 
continued,  and  that  this  treatment  had  had  the  happy  effect 


OF   NERVOUS    DISORDERS          299 

of  rendering  the  headaches  from  which  the  patient  had  suf- 
fered much  more  rare. 

Two  years  afterward  the  patient  returned  to  me.  Under 
the  influence  of  moral  preoccupation  she  had  become  nervous. 
The  constipation  had  returned,  and  my  confrere  seemed  dis- 
consolate at  this  backsliding,  because  the  patient  had  lost  all 
confidence  in  the  treatment.  It  took  me  only  a  half  hour 
in  conversation  to  show  the  patient  that  she  was  nervous, 
that  the  constipation  was  the  result  of  moral  depression,  and 
to  bring  back  her  confidence  in  training.  From  that  day  her 
functions  were  reestablished.  I  have  had  no  further  infor- 
mation on  the  course  of  events,  but  to  appreciate  the  efficacy 
of  these  measures  it  is  sufficient  to  know  that  this  constipation 
stopped  between  the  evening  and  the  following  morning  and 
that  for  two  years  there  was  no  relapse. 

The  very  presence  even  in  the  patient's  mind  of  counter- 
suggestions  it  not  a  serious  obstacle,  as  the  following  facts 
show: 

Madame  X.,  a  young  woman  twenty-two  years  of  age 
who  had  been  sent  to  me,  said  on  her  arrival :  "  My  step- 
sister, whom  you  cured  of  constipation,  is  very  anxious  to 
have  me  take  your  treatment,  but,  I  confess  to  you,  I  have 
come  without  a  shade  of  confidence !  " 

"  In  that  case,  madam,  you  had  better  go  away  again ;  but 
what  are  the  causes  of  your  serious  doubts  ?  " 

"  Oh,  well,  my  stepsister  was  thin  and  ate  nothing ;  her 
constipation  was  the  result  of  insufficient  food  and  it  lasted 
a  few  years.  You  induced  her  to  eat  normally,  and  she  grew 
strong  and  lost  her  constipation.  That  was  all  right,  and  I 
do  not  wish  by  any  means  to  undervalue  your  merit  in  this 
treatment.  But  I  am  in  a  wholly  different  condition.  I  eat 
like  an  ogre ;  you  could  not  make  me  eat  any  more ;  and,  what 
is  more,  I  have  been  constipated  from  my  earliest  childhood. 
This  trouble  was  the  torment  of  my  mother  when  I  was  a 
baby!" 

"  That  is  no  obstacle,  madam !  Follow  these  prescriptions 
which  I  will  give  you  here  in  writing  and  it  will  pass  away, 
believe  me ! "  The  very  next  day  she  had  a  spontaneous 


300  PSYCHIC   TREATMENT 

movement,  and  at  the  end  of  three  weeks  she  admitted  com- 
plete success. 

We  are  accustomed  to  hearing  of  the  same  kind  of  success 
from  the  hypnotizers.  They  often,  by  hypnosis  or  by  sug- 
gestion made  in  the  waking  condition,  succeed  in  reestablish- 
ing the  function  of  the  intestine,  either  during  the  seance  or 
at  its  expiration. 

Why  have  I  not  had  recourse  to  this  very  simple  means? 
Because  I  succeed  quite  as  well  with  the  prescriptions  which 
I  have  enumerated,  because  I  dislike  to  employ  common  sub- 
terfuges— that  is  to  say,  to  put  patients  to  sleep  and  pass  my 
hand  over  the  abdomen  to  create  the  idea  that  something  has 
been  done  to  them. 

Friction  on  the  abdomen,  through  the  clothes  or  on  the 
naked  skin,  only  acts  on  the  imagination,  and  it  is  useless  to 
speak  here  of  the  centripetal  stimuli,  which,  passing  through 
the  brain,  are  there  transformed  into  centrifugal  stimuli.  That 
is  too  simple  a  way  to  explain  the  action  of  mental  represen- 
tations. Without  doubt  suggestion  enters  into  these  treat- 
ments— at  least,  when  they  have  an  almost  immediate  effect 
like  those  which  I  have  related.  The  intestine  is  not  trained 
in  one  day. 

But  the  psychic  phenomenon  which  brings  about  the  cure 
is  certainly  complex,  and  it  is  worth  the  trouble  to  analyze  it. 
There  are  cases  where,  by  crude  suggestion  or  rational  per- 
suasion, the  only  thing  to  do  is  to  suppress  a  fixed  idea  of 
constipation.  In  fear  of  being  constipated,  the  patient  gets 
into  the  habit  of  using  artificial  means  every  day. 

M.  de  T was  a  selfish  and  hypochondriacal  old  man 

who  suffered  continually  with  pain  in  the  rectum.  For 
twenty  years  he  had  taken  an  enema  every  day.  He  had  never 
dared  to  try  to  do  without  one. 

In  a  consultation  I  said  to  my  confrere :  "  We  shall  never 
be  able  to  rid  this  patient  of  his  rectal  pain  (there  was  no 
reason  evident)  if  we  do  not  succeed  in  keeping  his  attention 
away  from  his  rectum.  We  have  got  to  make  him  stop  his 
enemas."  "  I  have  been  trying  to  do  that  for  twenty  years," 


OF  NERVOUS    DISORDERS          301 

replied  the  physician  of  the  patient.  "  I  shall  be  very  much 
astonished  if  you  succeed." 

We  returned  to  the  patient,  and  I  showed  him  the  necessity 
of  stopping  enemas  which  could  only  irritate  the  intestine 
and  keep  the  pain  going.  He  immediately  opposed  me  as 
tho  he  would  not  hear  of  it.  There  was  veritable  agony  de- 
picted on  his  countenance  at  such  a  proposition;  he  declared 
to  me  that  a  single  day  of  constipation  would  be  enough  to 
plunge  him  into  melancholy  and  to  lead  him  to  suicide! 

In  the  face  of  these  fears  I  adopted  the  manner  of  not 
wanting  to  take  upon  myself  the  responsibility  of  having  been 
the  cause  of  his  death ;  but  with  a  nonchalant  air,  and  as 
if  I  were  only  speaking  to  my  confrere,  I  expressed  the  idea 
that  enemas  taken  every  day  could  not  always  be  tolerated 
without  danger.  There  was  danger  of  chronic  irritation  by 
the  introduction  of  a  tube,  and  by  the  contact  of  water  with 
the  mucous  membrane;  for  it  is  well  known  that  cancers 
occur  spontaneously  in  these  membranes  which  have  been 
subject  to  mechanical  or  chemical  irritations ! 

At  these  words  the  patient  became  restless.  He  saw  him- 
self already  attacked  by  cancer.  He  consented  to  make  the 
attempt  to  have  a  movement  before  the  enema  was  used  and 
to  go  without  one  for  a  day.  He  succeeded  from  the  first 
day,  and  since  then  has  had  no  more  constipation! 

I  followed  the  patient's  history  for  several  years.  He  con- 
tinued his  training  for  a  fixed  period  with  such  earnestness 
that  he  came  to  me  very  much  disturbed  on  the  day  when 
the  Swiss  adopted  the  time  of  central  Europe.  He  was  afraid 
that  this  would  upset  all  his  habits! 

I  obtained  the  same  success  in  a  man  forty-eight  years  of 
age  who  also  had  taken  enemas  every  morning.  I  succeeded 
in  suppressing  his  terror  of  the  melancholia  that  he  feared 
was  threatening  him,  and  from  the  next  day  the  patient  had 
spontaneous  movements.  It  seemed  to  me  that  these  patients 
were  not  truly  constipated.  They  had  the  phobia  of  consti- 
pation and  their  foolish  fears  were  overcome  by  a  word. 

I  also  attribute  a  very  real  reaction  to  overfeeding,  to  a 
somewhat  vegetarian  diet,  and  the  glass  of  water  taken  on  an 


302  PSYCHIC   TREATMENT 

empty  stomach  on  waking  and  getting  up.  All  this  contrib- 
utes to  the  direct  stimulation  of  peristaltic  movement.  Fi- 
nally, in  patients  in  whom  the  effect  is  obtained  slowly,  one 
can  explain  the  result  by  the  organic  habit  to  which  the  in- 
testine is  just  as  much  a  slave  as  the  other  organs. 

Suggestion  and  persuasion,  which  I  shall  always  oppose 
one  to  the  other,  altho  they  often  produce  the  same  immediate 
effects,  can  also  act  by  suppressing  untoward  voluntary  in- 
fluences. 

Let  me  explain.  The  functioning  of  our  splanchnic  organs 
is  automatic.  It  is  the  same  with  certain  voluntary  move- 
ments, which  by  their  frequent  repetition  become  automatic. 
The  virtuoso  does  not  voluntarily  move  his  fingers;  he  lets 
them  have  free  course  on  his  instrument.  The  act  of  swal- 
lowing is  accomplished  as  a  reflex  when  the  food  reaches  the 
back  of  the  throat.  Micturition  and  defecation  are  usually 
spontaneous.  Therefore,  when  by  an  awkward  effort  the  will 
intervenes  in  an  act  which  is  normally  automatic,  it  disturbs 
the  functioning  of  the  organ. 

The  pianist  may  perhaps  be  stopped  in  his  playing  if  he 
tries  conscientiously  to  execute  such  or  such  a  passage;  he 
succeeds,  on  the  other  hand,  if  he  lets  the  medullary  centers 
act.  Many  persons  can  not  swallow  pills.  Fearing  lest  they 
enter  the  larynx,  they  make  voluntary  efforts  at  swallowing 
that  are  so  badly  executed  that  they  get  the  pill  in  the  roof 
of  their  mouth. 

The  fear  of  not  being  able  to  urinate  leads  to  retention, 
and  there,  also,  suggestion  and  encouragement  are  enough  to 
remove  the  obstacle.  I  have  often  found  this  to  be  so  in  my 
consultations.  I  have  been  accustomed  to  examine  the  urine 
of  each  of  my  patients  during  their  visit,  and  to  do  this  I 
ask  the  men  to  go  into  a  closet  close  by.  The  usual  reply  is : 
"  But,  doctor,  I  can  not ;  I  have  just  urinated  before  coming 
to  see  you."  I  reply :  "  That  makes  no  difference,  one  can 
urinate  every  five  minutes."  The  patient  is  willing  to  try, 
but  his  efforts  are  in  vain,  and  he  comes  back  into  my  room, 
disappointed,  saying:  "Decidedly,  it  won't  work!"  I  send 
him  back,  saying :  "  But  pardon,  it  always  works !  Try  it 


OF   NERVOUS    DISORDERS          303 

over  again,  but  do  not  strain;  just  let  it  come."  These  are 
two  very  different  actions.  In  ninety-nine  out  of  a  hundred 
cases  I  obtain  the  desired  result. 

Something  of  the  same  kind  happens  in  the  voluntary 
attempt  at  defecation.  In  one  it  is  the  fear  of  not  succeed- 
ing; in  another  the  anticipated  conviction  of  failure  which 
encourages  the  physiological  reaction.  The  desire  to  obtain 
the  result  too  quickly  may  effect  the  nervous  action;  in  short, 
the  clumsy  and  too  hasty  intervention  of  the  will  may  likewise 
lead  to  failure. 

A  good  woman  who  had  already  succeeded  a  few  times 
in  obtaining  a  result  spontaneously  made  the  following  ob- 
servation: "  When  I  try  too  hard  I  do  not  succeed;  but,  on 
the  other  hand,  when  I  put  on  my  spectacles  and  read  a  news- 
paper it  comes  of  itself !  " 

This  same  treatment  of  training  may  be  applied  to  other 
intestinal  disorders,  and  to  patients  who  under  various  influ- 
ences pass  from  diarrhea  to  constipation.  It  is  more  difficult, 
it  is  true,  to  obtain  results  from  it  in  chronic  diarrheas.  What- 
ever may  be  the  disorder  the  necessity  of  creating  good  in- 
testinal habits  is  always  indicated. 

But  it  is  in  habitual  constipation  that  the  method  shows 
its  constant  efficacy.  It  acts  in  various  ways :  by  physiological 
influences  due  to  a  hearty  diet  that  is  more  vegetarian  than 
animal ;  by  the  drinking  of  a  glass  of  water ;  by  the  effects  of 
iiabit  created  by  making  the  attempt  at  a  stated  hour;  by  the 
suppression  of  various  ideas  which  produce  on  these  functions 
an  inhibitory  action. 

I  have  indicated  that  there  is  a  more  complex  psychology 
of  constipation  than  one  would  think,  and  that  the  various 
mental  representations  can  hinder  functioning.  Suggestion, 
like  persuasion,  suppresses  these  mental  obstacles.  If  I  have 
insisted  so  strenuously  on  this  statement,  it  is  chiefly  because 
it  constantly  gives  such  valuable  results.  At  the  same  time 
these  phenomena  bring  up  interesting  questions  of  physio- 
logical psychology.  This  treatment  may,  in  fact,  serve  as  a 
sort  of  touchstone  to  test  the  mentality  of  the  physician  who 
uses  it,  as  well  as  his  therapeutic  ability,  and  I  would  dare  to 


304  PSYCHIC   TREATMENT 

say  to  the  physician  who  does  not  succeed  in  curing  by  these 
means  the  majority  of  cases  of  habitual  constipation :  "  You 
do  not  seem  to  me  to  have  the  necessary  qualities  for  the 
exercise  of  the  art  of  healing.  At  all  events,  do  not  use 
hypnosis,  nor  suggestion  in  a  waking  state;  do  not  think  of 
psychotherapy;  for  you  have  neither  the  suggestive  authority 
which  works  wonders,  nor  the  gift  of  persuasion  which  will 
always  be  the  dominant  quality  of  the  practising  physician." 


OF  NERVOUS   DISORDERS         305 


CHAPTER   XXIV 

Disturbances  of  Circulation  —  Emotional  Tachycardia  —  Basedow  Symp- 
toms— Permanent  Tachycardia :  Its  Existence  in  the  Tuberculous — 
Arythmia :  Intermittent,  Accidental  Murmurs  —  Suppression  of  Car- 
diac Disturbances  by  Psychotherapy — Nervous  Dyspnea — Convulsive 
Cough — Stuttering — Nervous  or  Hysterical  Aphonia — Mutism 

THE  circulation  is  often  disturbed  in  the  psychoneuroses. 
Sometimes  there  are  palpitations  and  cardiac  troubles,  some- 
times phenomena  of  vascular  contraction  and  vascular 
dilatation.  The  appearance  of  these  disorders  has  nothing 
astonishing  in  it  when  one  remembers  how  pallor  and  blush- 
ing express  feelings  of  fear  or  shame.  The  heart  participates 
so  constantly  in  all  our  emotional  movements  that  popular 
language  considers  the  heart  as  the  seat  of  the  feelings,  leav- 
ing to  the  brain  the  colder  role  of  reasoning  thought. 

What  one  observes  most  frequently  in  nervous  patients  is 
emotional  tachycardia.  Patients  do  not  always  accept  this 
adjective,  because  they  do  not  clearly  see  the  emotion  which 
has  accelerated  the  heart  beats.  But  it  is  easy  to  detect  it  in 
the  very  act  and  to  show  them  how  almost  always  some  con- 
scious or  subconscious  psychic  phenomenon  has  determined 
the  cardiac  trouble. 

In  many  neurasthenic  and  hysterical  patients  one  detects 
first  of  all  variability  of  the  heart  rhythm.  The  moment  the 
patient  is  approached  the  pulse  becomes  rapid.  Sometimes 
it  is  normal  at  the  start  but  accelerates  from  the  time  one 
begins  to  count  it.  A  sudden  noise  or  a  question  which 
frightens  the  patient  is  enough  to  make  the  heart  gallop. 
Cardiographic  researches  have  shown  that  these  variations  are 
possible  in  health;  but  the  facility  with  which  they  become 
established  indicates  a  degree  of  emotion  in  the  patient,  which 
is  also  manifested  by  the  timidity  and  facility  to  blush. 


306  PSYCHIC   TREATMENT 

In  other  patients  the  tachycardia  is  permanent,  and  seems 
more  independent  of  the  mental  life.  One  would  believe  one's 
self  in  the  presence  of  a  case  of  undeveloped  Basedow's  dis- 
ease, without  goitre  and  without  exophthalmia.  The  look  is 
often  slightly  staring,  the  eye  is  brilliant  and  restless.  The 
analogy  is  evident,  and  there  is  nothing  to  be  astonished  at. 
In  spite  of  modern  researches,  which  attribute  the  majority 
of  the  symptoms  of  exophthalmis  goitre  to  hyperactivity  of 
the  thyroid,  in  spite  of  the  evident  success  of  certain  surgical 
interventions,  it  is  none  the  less  true  that  in  this  disease  we 
have  to  do  with  a  nervous  malady.  Person's  afflicted  with 
Basedow's  disease  show  the  mental  stigmata  of  the  neuroses, 
particularly  the  exaggerated  emotionalism,  and,  in  looking 
into  the  past  history  of  the  patients,  one  verifies  the  fact  that 
this  nervousness  has  existed  in  them  long  before  the  beginning 
of  the  disease.  One  finds  a  neuropathic  heredity  in  them. 
At  last  one  finds  Basedow's  disease  occurring  in  an  acute  and 
often  fatal  form  under  the  sole  influence  of  an  emotion.  In 
a  few  days  I  lost  two  patients  in  whom  the  disease  became 
manifest  on  the  day  of  the  death  of  their  husbands. 

The  forms  of  permanent  tachycardia  of  the  neuroses  also 
seem  due  to  an  organic  cause,  perhaps  to  an  autointoxication, 
secondary  to  a  psychic  condition.  The  prognosis  is  less  fav- 
orable than  when  transient  palpitations  follow  an  emotional 
movement.  We  are  always  more  disarmed  when  we  can  not 
discover  the  origin  of  the  functional  trouble. 

One  often  observes  this  tachycardia,  whether  isolated  or 
accompanied  by  a  condition  of  psychoneurosis,  of  agitation, 
at  the  commencement  of  certain  tuberculous  affections.  It 
is  probable  that  the  attack  on  the  physical  health  determines, 
in  such  subjects  as  are  naturally  predisposed,  this  breaking 
out  of  nervousness.  When  one  has  to  do  with  an  agitated 
nervous  person  who  has  red  cheeks,  a  permanent  tachycardia 
and  dyspnea,  and  who  is  rapidly  growing  thin,  one  must  be 
careful.  There  is  a  snake  in  the  grass,  and  auscultation  will 
often  reveal  incipient  tuberculosis. 

There  are,  nevertheless,  patients  in  whom  permanent  tachy- 
cardia is  due  to  a  psychic  cause.  There  are  patients  who  are 


OF   NERVOUS    DISORDERS          307 

not  overcome  by  any  actual  occurrence,  but  who  live  in  a 
continual  state  of  uneasiness,  in  an  agony  of  expectation,  with- 
out being  able  to  analyze  their  fears.  The  mental  condition 
being  continually  one  of  agitation,  this  emotional  tachycardia 
becomes  permanent,  and  it  is  then  very  difficult  to  suppress 
the  cause  and  to  undertake  a  promptly  efficacious  treatment. 

Cardiac  arythmia  may  be  manifested  not  only  by  variations 
in  the  frequency  of  the  tension  of  the  pulse,  but  also  by  an 
intermittent  action.  Sometimes  the  dropped  beats  occur  regu- 
larly, occurring  after  three,  four,  or  five  pulsations ;  some- 
times they  appear  only  at  long  intervals,  as  a  false  beat  of 
the  heart.  I  have  felt  some  doubt  as  to  the  nervous  nature 
of  these  irregularities.  I  would  not  dare  state  that  they  are 
not  due  to  cardiac  lesions  or  to  intoxications.  If  the  patient 
has  reached  the  age  of  arteriosclerosis,  or  if  he  is  a  syphilitic 
of  long  standing,  one  must  reserve  his  judgment. 

I  will  express  myself  in  the  same  dubious  fashion  on  the 
subject  of  the  soft  murmurs  which  are  heard  at  the  apex  over 
the  ventricle  or  at  the  pulmonary  valve,  and  which  are  desig- 
nated by  the  name  of  accidental  murmurs.  We  are  by  no 
means  certain  of  the  mechanism  of  their  production.  I  ought, 
however,  to  say  that  I  have  observed  these  various  troubles  in 
the  psychoneuroses  without  seeing  any  phenomena  of  stasis 
occurring  later.  I  have  been  able,  in  several  cases,  to  bring 
about  a  cure  after  a  treatment  which  had  improved  the  mental 
condition.  It  is  just  here  that  rest  in  bed  during  the  treat- 
ment by  isolation  may  act  directly  upon  these  functional 
troubles. 

What  is  the  course  to  pursue  in  the  presence  of  these 
nervous  cardiac  disturbances? 

One  must  first  examine  the  patient.  That  goes  without 
saying,  you  will  say.  Yes,  that  goes  without  saying;  but 
nevertheless,  it  is  not  always  done.  It  is  by  no  means  suffi- 
cient to  lay  one's  ear  negligently  on  the  patient's  breast  against 
his  clothes  as  so  many  practitioners  do.  It  is  necessary  to 
make  a  thorough  examination  by  inspection,  palpation,  per- 
cussion, and  careful  auscultation.  One  must  take  into  con- 
sideration the  condition  of  the  liver  and  the  lungs,  analyze 


308  PSYCHIC  TREATMENT 

the  urine,  and  feel  the  pulse — not  only  to  count  it,  but  to  de- 
termine its  tension  and  character;  one  must  note  the  slightest 
symptoms  of  stasis. 

It  is  necessary  for  this  examination  to  be  sufficiently  com- 
plete and  sure  for  one  to  dare  to  be  affirmative,  so  that  he 
may  with  a  good  conscience  declare  to  the  patient  that  there 
is  no  trouble  with  the  heart,  and  that  his  palpitations  are  nerv- 
ous. One  can,  in  this  simple  way,  stop  in  a  single  day  these 
cardiac  troubles,  which  have  for  months,  and  even  years  re- 
sisted the  greatest  variety  of  medicines. 

Here  is  an  example:  Mme.  R was  a  young  woman 

twenty-six  years  of  age,  who  seemed  to  enjoy  good  health. 
She  was  somewhat  thin,  but  the  chief  symptoms  noticeable 
were  evident  signs  of  exaggerated  emotionalism.  She  seemed 
restless  and  disconsolate  at  finding  herself  away  from  home 
and  condemned  to  a  treatment  of  isolation  which  her  physician 
advised.  For  four  months  she  had  lived  in  such  a  nervous 
condition  that  it  became  unbearable  to  her  friends.  Every 
night  she  wakened  with  a  great  start;  she  was  seized  with 
palpitation  of  the  heart,  accompanied  by  the  terrifying  sen- 
sation of  impending  death.  Her  husband  was  obliged  to  get 
up  every  night  to  give  her  medicine.  The  physician  of  the 
village  had  been  called  in,  and  had  tried  in  vain  to  calm  the 
patient.  They  had  a  consultation  in  the  city.  The  consultant 
diagnosed  a  condition  of  major  hysteria,  and,  feeling  himself 
incapable  of  taking  care  of  the  patient,  sent  her  to  me. 

Her  husband  told  me  all  this,  and  said  to  me :  "  My  wife 
has  such  a  fear  of  death  that  one  can  hardly  say  the  dread 
word  in  her  presence."  In  fact,  the  patient  immediately  burst 
into  tears,  and  cried :  "  Oh,  yes ;  if  I  have  to  die,  I  would 
rather  die  right  away !  " 

I  really  had  some  trouble  in  making  up  my  mind  to  under- 
take the  treatment  of  one  who  possessed  such  a  childish  men- 
tality. Seeing  that  she  would  not  submit  to  isolation,  I  asked 
her  husband  to  remain  in  town,  thinking  she  would  not  hold 
out  alone  for  a  day,  but  would  go  away  if  he  went.  But 
nothing  of  the  kind  occurred.  The  patient  established  herself 
bravely.  I  examined  her  thoroughly  and  was  able  to  say  to 


OF   NERVOUS   DISORDERS          309 

her :  "  Madam,  you  are  young,  vigorous,  and  in  good  health. 
Your  constitution  is  excellent.  The  palpitations  of  your  heart 
are  only  nervous.  There  are  no  symptoms  of  heart  disease. 
However  rapid  your  pulsations  may  be  there  will  .lever  be 
any  danger.  It  is  fear  which  throws  you  into  this  condition. 
Believe  me,  if  you  could  lose  your  sense  of  fear,  all  these 
troubles  would  stop  immediately.  Do  not  forget  that  nothing 
can  make  the  heart  beat  like  the  emotion  of  fear.  Suppose 
that  you  do  wake  up  with  palpitation  of  the  heart.  It  has 
arisen,  perhaps,  from  an  emotional  dream  which  has  been  for- 
gotton,  or  else  it  is  due  to  the  action  of  coffee  or  tea.  How 
do  I  know?  If,  disturbed  by  this  experience,  you  take  fright, 
if  you  think  of  the  possibility  of  a  fatal  result,  you  create  an 
emotional  state.  Therefore,  as  emotion  makes  the  heart  beat, 
the  pulse,  which  was  beating  at  the  rate  of  100,  is  going  to 
mount  up  to  120.  At  this  number  the  discomfort  increases 
and  the  emotion  would  seem  still  more  justified.  Then  the 
pulse  reaches  140.  On  the  other  hand,  if  you  can  persuade 
yourself  that  there  is  nothing  the  matter  with  you,  you  will 
lose  your  fears  and  your  pulse  will  slow  down." 

The  next  morning  I  found  the  patient  very  brave ;  she  had 
slept  well  and  I  was  ready  to  delude  myself  with  having  cut 
all  these  symptoms  short  by  a  single  conversation.  But  the 
conclusion  was  premature  and  I  detected  a  preconceived  idea 
in  my  patient.  She  explained  her  well-being  for  these  two 
days  by  the  fact  that  she  was  unwell,  for  she  said  that  the 
palpitations  always  stopped  during  the  time  of  her  menstrual 
period,  but  reappeared  on  the  very  moment  when  the  flow 
ceased. 

I  combated  this  autosuggestion  by  saying  to  her :  "  I  agree 
that  the  coincidence  may  have  been  regular  and  your  obser- 
vation just.  But  please  give  up  any  idea  of  such  a  relation 
between  a  disastrous  cause  and  effect.  As  long  as  you  believe 
in  the  necessary  succession  of  the  phenomena,  as  long  as 
toward  the  end  of  your  periods  you  expect  palpitation  of  the 
heart,  it  will  be  forthcoming.  Do  not  think  of  your  former 
experiences,  however  logical  they  may  seem.  Keep  this  syllo- 
gism in  mind :  '  I  am  young,  strong,  and  healthy ;  I  have  no 


310  PSYCHIC   TREATMENT 

disease  of  the  heart,  and  no  organic  affection.  I  can  not  die 
of  that !  '  Then  your  heart  will  ceasfr  to  beat  too  quickly,  the 
distress  will  disappear,  and  you  will  sleep  like  a  child." 

As  I  said,  so  it  was.  After  a  month  I  could  not  detect 
any  cardiac  trouble  in  her.  It  was  not  only  that  the  palpi- 
tation had  completely  ceased,  but  the  patient  often  awakened 
in  the  night  in  distress  and  seized  with  the  heart  beats  which 
had  hitherto  gotten  her  husband  and  the  physician  up  every 
night.  But  the  idea  never  came  to  her  to  ring  for  the  Sister. 
"  I  had  some  palpitation  of  the  heart  last  night,"  she  would 
say,  smilingly,  "  but  I  quickly  got  rid  of  it.  I  recalled  what 
you  told  me:  that  I  had  no  disease  of  the  heart  and  that  one 
never  died  of  nervous  palpitation.  I  became  quiet  and  turned 
over  on  the  other  side  and  went  to  sleep."  I  learned  later 
that  the  cure  had  persisted.  The  patient  only  showed  the 
slightest  traces  of  nervousness  in  the  presence  of  the  daily 
cares  of  life. 

Cases  of  this  kind  are  not  rare.  Every  year  I  see  persons 
who  for  a  long  time  have  suffered  from  palpitations  and  who 
lose  them  after  one  or  two  conversations.  There  are  some 
who  still  remain  subject  to  tachycardia,  but  no  longer  suffer 
from  it,  because  they  have  learned  not  to  be  disturbed  by  it. 
But  there  are  also  more  rebellious  neurasthenics,  who  under- 
stand all  that  is  said  to  them,  and  even  experience  a  relief  for 
a  few  hours  or  days,  but  who  fall  back  into  their  phobias 
which  bring  on  the  palpitations.  Thus  one  must  redouble 
one's  patience  and  always  return  to  the  same  subject,  and 
hammer  into  the  patient's  head  the  idea  of  the  complete  lack 
of  danger  of  these  cardiac  troubles.  He  must  be  convinced 
by  the  recital  of  former  cases  and  successful  cures;  he  must 
have  a  clear  and  precise  theory  of  emotion  set  before  him, 
with  special  stress  put  on  the  purely  psychic  origin  of  these 
phenomena.  There  are  even  incurable  cases.  It  sometimes 
becomes  impossible  to  calm  the  patient,  or  else,  after  a  greater 
or  less  improvement,  he  falls  back  into  his  phobias  and  de- 
velops serious  hypochondria. 

The  patients  have  a  tendency  to  see  a  physical  phenomenon 
in  emotion,  and  I  hear  them  say :  "  But,  doctor,  I  can  not, 


OF  NERVOUS   DISORDERS         311 

nevertheless,  keep  myself  from  having  palpitations  when  the 
presence  of  such  or  such  a  person  or  the  announcement  of 
such  or  such  an  event  affects  me." 

"  You  are  right,"  I  reply ;  "  you  can  not  hold  back  an  emo- 
tional feeling  that  has  already  commenced  any  more  than 
you  could  stop  the  electric  current  when  you  have  closed  the 
circuit  by  pressing  on  the  call  button.  But  an  excellent  way 
to  keep  the  bell  from  ringing  is  not  to  press  the  button.  Learn 
to  repress  by  a  healthy  confidence  in  yourself  the  timidity 
which  makes  your  heart  beat;  force  yourself  to  bear  its  an- 
noyances with  an  easy  stoicism.  Thus  you  will  keep  your 
calmness  of  mind  and  your  heart  will  stay  quiet." 

I  never  give  medicines  in  such  cases  of  tachycardia,  or  at 
most,  only  occasionally,  to  help  the  work  along,  I  give  a  little 
bromide  of  potassium.  As  a  rule,  digitalis  and  strophanthus 
have  as  little  effect  in  nervous  tachycardia  as  in  the  tachy- 
cardia of  Basedow's  disease. 

Medicines  are  not  only  useless,  they  are  dangerous.  If 
there  are  some  cases  where  they  act  favorably  by  suggestion, 
there  are  others,  more  numerous,  where  the  use  of  a  remedy, 
particularly  an  anodyne,  gives  to  the  disease  the  stamp  of  re- 
ality, which  is  exactly  what  it  ought  not  to  have  in  the  patient's 
mind.  It  awakens  the  idea  of  an  organic  affection  when  the 
first  consideration  of  the  physician  ought  to  be  to  dissipate 
in  the  patient's  mind  all  fear  and  all  idea  of  danger.  The 
physician  who  is  sure  of  his  diagnosis  of  nervous  tachycardia 
oug' . t  to  be  able  to  prove  it  by  psychotherapy. 

It  is  the  same  in  nervous  dyspnea.  One  often  notices  dis- 
turbances of  the  respiration  in  the  neuroses :  slight  acceleration 
of  the  respiratory  movement,  irregularities  of  rhythm,  and 
sighs.  Many  complain  of  a  purely  subjective  sensation  of 
distress,  but  these  symptoms  pass  almost  unperceived  in  the 
midst  of  the  gravest  functional  disorders.  There  are,  never- 
theless cases  where  a  real  dyspnea,  causing  frequent  respi- 
rations (40,  50,  or  60  a  minute),  seems  to  constitute  either  for 
a  short  time  or  during  long  periods  the  predominant  symptom 
of  nervousness. 

The  indication  remains  the  same  as  in  tachycardia:  the 


312  PSYCHIC  TREATMENT 

patient  must  be  quieted  and  made  to  forget  his  dyspnoea.  Often 
the  only  things  necessary  are  a  few  statements  corroborated 
by  the  attitude  of  the  physician  toward  the  patient. 

M.  X.,  a  young  man  seventeen  years  of  age,  had  suffered 
from  rheumatism,  and  for  a  long  time  had  shown  hysteriform 
symptoms  mingled  with  phobias,  and  morbid  impulses  which 
are  sometimes  very  disturbing.  He  was  afraid  that  he  would 
throw  himself  out  of  the  window,  and  plucked  out  his  growing 
beard  by  the  root,  under  the  pretext  that  it  was  not  beautiful. 
One  day  he  even  became  delirious,  and,  believing  himself  to 
be  a  king,  sat  down  upon  a  sofa,  his  throne,  and  placed  his 
august  feet  upon  a  red  cushion!  It  used  to  be  the  fashion 
to  place  these  delirious  obsessions  in  the  group  with  insanities 
of  degeneracy.  Nevertheless,  my  patient  has  been  very  well 
for  years.  He  was  cured  as  easily  as  an  ordinary  neuras- 
thenic. 

I  had  already  observed  some  dyspneic  phenomena  in  this 
patient,  when  one  day  they  came  to  call  me  into  a  neighboring 
room.  The  Sister  had  suddenly  opened  the  door  of  the  pa- 
tient's room  and  quite  desperately  called  to  me: 

"  Come  quickly,  this  gentleman  can  scarcely  breathe." 

"  Well,"  I  replied,  tranquilly,  "  I  will  come  as  soon  as  I 
have  finished  my  visit  to  madam,"  and  I  went  on  with  my 
conversation.  However,  I  cut  it  short  a  little;  then,  going 
into  the  room  of  my  young  man,  I  took  good  care  not  to  rush 
to  his  aid.  I  walked  placidly  to  the  other  end  of  the  room, 
took  a  chair  from  there,  carried  it  toward  the  patient's  bed, 
placed  it  carefully  on  the  rug,  and  lifted  up  the  tails  of  my 
coat  with  special  care,  and  with  the  greatest  calmness  asked 
what  had  happened. 

The  patient  was  already  calmed,  for  he  had  perfect  con- 
fidence in  me;  he  knew  that  I  was  interested  in  him,  and  my 
calm  attitude  suggested  to  him  a  sense  of  well-being,  and 
gave  him  assurance  that  he  was  by  no  means  at  the  point  of 
death. 

I  auscultated,  felt  his  pulse,  assured  him  that  there  was  no 
danger  and  that  he  could  lie  down  without  fear.  I  gave  him 
a  little  medical  lecture,  explaining  to  him  that  the  true  dyspnea 


OF  NERVOUS   DISORDERS         313 

of  cardiac,  emphysematous,  or  renal  origin,  often  necessitated 
the  sitting  position  which  he  had  taken,  but  that  this  attitude 
was  of  no  service  in  dyspnea  of  psychic  origin.  At  the  end 
of  a  few  moments  my  patient  was  breathing  like  anybody 
else,  and  from  that  time  I  did  not  have  to  concern  myself 
with  this  symptom. 

About  a  year  later  he  was  again  taken  with  dyspneic 
symptoms  at  home.  The  physician  who  was  called  in  spoke 
of  pulmonary  congestion,  which  frightened  the  patient  ex- 
ceedingly. He  prescribed  topical  applications  and  sedatives. 
His  condition  only  grew  worse,  and  so  much  so  that  the 
patient  came  to  see  me.  A  thorough  examination  of  the 
heart  and  lungs  made  me  certain  of  nervous  dyspnea.  I  dis- 
pelled all  his  fears  by  persuasion,  and  the  cure  was  decided. 

Before  I  had  recognized  the  efficacy  of  this  psychic  ther- 
apy— it  was  during  my  residence  as  interne — I  had  cut  short 
a  dyspnea  of  this  kind  by  a  few  doses  of  bromide. 

It  happened  in  a  young  girl  nineteen  years  of  age,  who 
always  breathed  when  awake  at  the  rate  of  fifty-six  respira- 
tions to  the  minute.  The  most  careful  examination  did  not 
reveal  any  lesion  whatsoever;  but,  on  the  other  hand,  she  did 
not  have  any  'stigmata  of  hysteria.  This  dyspnea  lasted  for 
some  weeks  without  any  cough  or  expectoration,  and  yielded 
neither  to  rest  in  bed  nor  to  the  anodynes  which  were  suc- 
cessively tried.  Morphine  in  particular  had  no  effect.  A  few 
spoonfuls  of  ten  per  cent,  solution  of  bromide  had  a  definite 
effect  upon  this  strange  polypnea.  To-day  I  suspect  sugges- 
tion of  having  produced  the  effect. 

A  continual  nervous,  barking  cough  that  comes  and  goes 
will  often  yield  to  the  use  of  bromide  when  the  indication 
is  for  rational  measures.  But  I  find  often  that  suggestion  is 
enough.  The  practise  follows  the  preaching. 

Mile.  C was  a  strong  individual,  eighteen  years  of 

age,  who  boarded  in  a  little  neighboring  village.  She  found 
it  pleasant  there,  and  preferred  to  live  with  friends  rather 
than  in  her  family  circle,  which  was  not  congenial  to  her.  It 
was  against  her  wish  that  she  was  taken  from  her  pension  to 


314  PSYCHIC   TREATMENT 

consult  me;  for  her  first  question  after  her  examination  was: 
"  When  can  I  return  to  my  boarding-school  ?  " 

Appreciating  the  importance  that  there  was  in  making  the 
most  of  this  state  of  mind,  I  replied :  "  Well,  mademoiselle, 
I  do  not  know.  Just  as  long  as  you  cough  in  this  spasmodic 
way  you  can  not  return  there.  I  am  sorry  for  it,  but  this 
cough  disturbs  the  lessons  at  which  you  are  present  and  tires 
your  teachers;  and,  furthermore,  there  is  danger  for  your 
friends  of  nervous  contagion.  Stay  at  your  mother's  house 
and  drink  a  little  Ems  water !  "  I  myself  was  astonished 
when  I  found  that  this  cough  stopped  between  the  evening 
and  the  morning,  even  tho  it  had  lasted  for  some  weeks  be- 
fore. The  patient  went  back  to  her  pension  three  days  later ! 

In  many  cases  it  is  not  easy  to  hit  upon  the  best  means  to 
detect  the  favorably  psychological  situation,  and  if  one  does  not 
wish  to  resort  to  hypnosis  he  succeeds  more  often  with  prepa- 
rations which  soothe  the  cough.  I  give  the  preference  to 
potassium  bromide  as  inoffensive,  but  the  further  I  progress 
in  my  career  the  more  I  try  to  find  in  the  mental  life  of  the 
subject  the  origin  of  the  convulsive  cough,  and  to  discover  the 
mental  obstacles  which  oppose  the  cure.  I  have  seen  many 
patients  whose  hysterical  symptoms,  among  which  was  a  cough, 
were  only  due  to  unfavorable  moral  influences,  resulting  from 
family  friction.  It  has  often  been  possible  for  me  to  bring 
about  a  cure  by  withdrawing  the  patient  from  the  midst  of 
the  family,  and  at  other  times  by  showing  him  the  value  of 
the  spirit  of  endurance.  It  is  always  by  studying  the  men- 
tality of  a  subject  and  the  way  he  feels  and  acts  that  one  can 
succeed  in  revealing  the  causes  of  the  trouble  and  in  combat- 
ing it. 

The  same  psychological  study  is  necessary  in  certain  forms 
of  emotional  stuttering,  in  which  the  phonation  is  disturbed 
by  irregularities  of  respiration. 

It  still  remains  for  me  to  speak  of  a  trouble  of  the  respira- 
tory apparatus — namely,  nervous  aphonia.  It  is  an  hysterical 
symptom,  and  one  of  the  most  characteristic,  but  I  have  said 
how  little  I  keep  to  these  names.  This  aphonia  is  observed, 
as  well  as  hysterical  mutism,  in  persons  who  have  never  shown 


OF  NERVOUS   DISORDERS         315 

any  other  signs  of  serious  nervousness,  and  who  may  be  free 
from  it  all  the  rest  of  their  lives. 

Aphonia,  like  mutism,  occurs  always  as  the  result  of  an 
autosuggestion  of  helplessness,  whether  it  follows  a  movement 
of  conscious  or  subconscious  timidity,  or  whether  it  has  for 
its  starting-point  a  fortuitous  trouble  of  phonation.  Hoarse- 
ness, occasioned  by  a  cold  or  by  the  inhalation  of  gas  or  dust, 
is  enough  to  give  rise  to  the  mental  representation  of  help- 
lessness. 

It  is  not  always  possible  to  follow  in  every  case  the  asso- 
ciation of  ideas  which  has  led  to  aphonia  or  mutism,  but  the 
very  method  of  curing  these  troubles  shows  their  psychic 
origin. 

All  physicians  can  cure  these  patients,  and  all  means  are 
good  if  they  suggest  the  conviction  of  cure.  Everything  has 
been  used  for  this  end :  douches,  air  treatment,  and  baths.  The 
larynx  has  been  electrified  through  the  skin  or  by  applying 
an  electrode  to  the  vocal  cords.  Faradization  has  succeeded 
as  well  as  the  application  of  static  sprays  or  sparks.  Cure 
has  been  suggested  by  the  exercises  of  phonation  and  respira- 
tory gymnastics.  At  Lyons,  in  the  laryngological  clinic,  they 
suddenly  compress  the  thorax  while  the  patient  makes  the 
effort  of  phonation.  A  sound  is  produced  by  this  sudden  ex- 
piration ;  the  patient  believes  that  he  can  speak,  and  he  speaks. 

I  have  seen  an  aphonia  cease  suddenly  under  the  influence 
of  a  medicative  suggestion.  A  young  girl  fifteen  years  of 
age,  who  had  formerly  suffered  from  hysterical  mutism,  was 
taken  with  aphonia.  She  was  all  the  more  frightened  by  it 
because  she  had  to  take  part  the  next  day  in  a  religious  cere- 
mony where  she  had  to  make  a  response.  I  told  her  that  it 
was  nothing  at  all,  that  it  would  pass  away  and  that  she  would 
be  able  to  speak  the  next  day.  I  believe  I  could  have  been 
satisfied  with  this  suggestive  assurance,  but,  seized  with  timidi- 
ty, I  reflected  that  it  really  was  a  good  deal  to  exact  from  the 
patient's  credulity  to  thus  predict  a  cure  at  a  certain  time,  and, 
contrary  to  my  own  judgment,  I  helped  the  suggestion  along 
by  prescribing  a  tablet  of  antipyrine.  Ten  minutes  after  hav- 
ing taken  it  the  young  girl  was  talking.  She  has  never  suffered 


316  PSYCHIC  TREATMENT 

any  more  from  aphonia,  and  has  never  had  any  other  nervous 
symptoms.  When  I  saw  the  patient  later  I  did  not  hesitate 
to  reveal  the  secret  to  her  and  to  remark  that  it  was  not  the 
antipyrine  that  cured  her,  but  the  idea  that  she  was  going  to 
be  cured.  The  intelligent  young  woman,  who  is  really  a 
singer,  saw  the  advantage  there  was  in  laying  hold  of  the 
mechanism  of  the  cure,  and  I  believe  that  she  is  more  apt 
to  be  immune  to  aphonia  than  she  would  have  been  if  she  had 
continued  to  put  her  confidence  in  the  virtues  of  antipyrine. 

In  a  case  of  aphonia  lasting  for  six  months  I  intentionally 
used  a  method  of  negative  suggestion,  which  consists  in  ig- 
noring the  aphonia  and  not  concerning  myself  with  it  at  all. 
The  patient  had  a  whole  list  of  functional  troubles :  insomnia, 
diarrhea,  and  pain  in  her  legs.  At  her  visit  the  patient  said, 
in  a  voice  which  was  wholly  aphonic :  "  Doctor,  I  can  not 
always  speak." 

I  replied  neither  by  yes  nor  no;  I  acted  as  though  I  had 
not  heard  her,  and  immediately  I  questioned  her  concerning  her 
other  symptoms.  I  thus  tried  to  make  her  forget  her  trouble. 
This  succeeded  so  well  that  two  days  later  she  was  speaking 
out  loud.  Three  weeks  later  she  was  reflecting  on  her  cure, 
and  she  made  one  of  those  autosuggestions  so  familiar  to 
nervous  persons.  "  Doctor,"  she  said,  "  I  believe  that  it  is 
the  warmth  of  the  bed  that  has  cured  my  aphonia.  I  am  very 
much  afraid  that  it  will  come  back  when  I  go  away,  especially 
if  it  is  cold  weather." 

Then  I  suddenly  changed  my  tone.  "  Yes,"  I  said  to  her, 
"your  aphonia  will  come  back.  The  moment  that  you  sug- 
gest it  to  yourself  in  advance  you  will  have  it,  and  you  will 
keep  is  just  as  long  as  you  want  it!  But  I  can  also  tell  you, 
if  you  really  mean  to  keep  the  opposite  idea  in  your  head — 
that  is  to  say,  to  drive  out  the  idea  of  a  relapse — you  will  be 
cured.  Choose !  "  The  patient  went  away  cured,  and  had 
no  relapse,  in  spite  of  the  intense  cold  which  was  then 
prevalent. 

Since  then  I  have  taken  care,  in  all  patients  with  hysterical 
aphonia,  to  neglect  the  aphonia  just  as  I  forget  their  hemian- 
esthesia.  I  draw  all  their  attention  to  their  other  troubles, 


OF  NERVOUS   DISORDERS         317 

altho  it  may  be  more  distressing  for  them,  and  I  wait  patiently 
until  the  voice  comes  back.  I  have  never  had  to  wait  long. 

That  is  why  I  do  not  dream  of  using  hypnosis,  or  purely 
verbal  suggestion,  which  often  permits  one  to  obtain  a  more 
rapid,  but  not  a  more  sure,  cure.  In  the  majority  of  cases 
one  can  wait.  I  have  shown  that  in  this  influence  exercised 
on  the  patients  afflicted  with  the  various  functional  troubles 
of  the  digestive  apparatus  or  the  heart  or  the  respiratory  sys- 
tem, there  is  always  an  element  of  suggestion.  To  arouse  in 
the  patient  the  conviction  of  cure  is  the  fundamental  indica- 
tion. It  is  impossible  for  me  always  to  keep  the  patient 
from  reaching  this  conviction  by  blind  faith;  but  the  fault, 
if  fault  there  be,  must  be  imputed  to  the  subject.  Personally 
I  take  care  that  my  statements  are  rationally  founded ;  I  trans- 
mit to  the  patient  only  such  convictions  as  are  based  on  my 
psychological  or  physiological  views.  I  try  to  make  the  pa- 
tient follow  the  same  paths,  to  explain,  and  to  make  him 
understand  as  clearly  as  possible  the  influence  of  mental  rep- 
resentations on  organic  functions. 

The  hypnotizers  act  in  the  same  way  when  they  occasion- 
ally do  not  fear  to  apply  the  theory  of  suggestion.  But  they 
do  not  always  do  it,  and  often  keep  the  patients  in  such  a 
state  of  dependence  that  the  patients  are  frightened  by  it. 
There  are  some,  and  among  the  most  intelligent,  who  say  to 
their  suggester :  "  I  do  not  know  what  you  have  in  you,  but 
you  exercise  a  power  over  me  which  troubles  me.  I  have 
the  feeling  that  you  could  make  me  do  anything  that  you 
wanted !  " 

I  have  never  had  this  magic  power  attributed  to  me.  On 
the  contrary,  I  hear  them  say :  "  You  have  made  me  under- 
stand what  has  happened;  you  have  shown  me  how  I  have 
come  to  be  ill,  and  how  I  can  be  cured.  Now  that  you  have 
told  me  it  seems  very  simple  to  me  and  I  am  a  little  astonished 
that  I  should  not  have  found  it  out  alone." 

This  is  the  only  secret  of  a  rational  psychotherapy — to  ex- 
plain with  patience  and  gentleness,  varying  the  discourses 
according  to  the  faculties  of  the  questioner ;  make  him  under- 


318  PSYCHIC  TREATMENT 

stand  things  and  to  use  his  logical  faculties,  so  that  he  can  for 
himself  find  the  road  to  truth. 

I  can  not,  therefore,  dismiss  all  suggestive  influences  from 
my  treatment,  but  I  have  no  need  to  employ  them  to  put  my 
patient  on  a  sofa,  and  bend  him  under  a  yoke  by  putting  him 
into  a  more  or  less  profound  sleep,  and  fixing  his  arms  in  cata- 
lepsy. I  do  not  seek  to  plunge  him  into  an  atmosphere  of  hyp- 
notism by  receiving  him  in  a  softly  carpeted,  dimly  lighted 
room  and  to  make  a  favorable  impression  upon  him  by  the 
sight  of  other  people  sleeping  around. 

However  well  intentioned  they  may  be,  these  practises 
savor  of  charlatanism.  I  would  adopt  them  if  they  were 
necessary  for  the  patient's  welfare.  I  have  been  able  to  do 
without  them  after  having  used  them  with  a  knowledge  of 
their  cause,  and  I  am  happy  to  have  abandoned  them. 


OF  NERVOUS   DISORDERS         319 


CHAPTER   XXV 

Disturbances  of  Urinary  Functions — Retention  ;  Phobias — Nocturnal  In- 
continence  —  Polyuria  —  Pollakiuria  —  Qualitative  Modifications  of 
Urine  —  Disturbances  of  Sexual  Life;  Their  Frequency  in  the  Psy- 
choneuroses — Sexual  Psychopathy — Onanism — Physical  and  Psychic 
Influence — Menstruation  and  Menstrual  Psychoses — Nervousness  at 
the  Menopause — The  Critical  Age — Possibility  of  Piychotherapeutic 
Intervention  in  these  Various  Conditions 

THE  urinary  system  does  not  escape  from  the  influence 
of  psychoneuroses,  and  one  sees  retention  of  urine,  inconti- 
nence, polyuria,  and  pollakiuria.  The  bladder  and  the  kid- 
neys may  be  the  seat  of  various  painful  sensations. 

Retention  of  urine  is  frequent  among  the  hysterical.  It 
is  probable  that  to  a  certain  degree  distention  of  the  bladder 
brings  about  a  true  paralysis,  thus  making  evacuation  im- 
possible. The  bladder  may  then  contain  several  quarts,  and 
it  is  necessary  to  use  a  catheter;  one  often  succeeds  also  by 
manual  expression,  compressing  the  bladder  with  some  de- 
gree of  force  and  for  a  prolonged  time.  But  this  paretic  con- 
dition is  not  primary,  and  the  origin  of  the  retention  ought 
to  be  sought  in  the  mentality  of  the  subject.  As  in  aphonia 
and  astasia-abasia,  there  is  in  such  cases,  first  and  foremost, 
a  conviction  of  helplessness.  It  is  generally  impossible  to  dis- 
entangle the  skein  of  mental  representation  and  to  assign  to 
this  trouble  of  micturition  any  precise  psychic  cause.  How- 
ever, one  will  sometimes  find  it  in  feelings  of  embarrassment 
or  timidity;  at  other  times  one  recognizes  the  influence  of 
letting  the  attention  dwell  upon  the  sexual  organs,  or  of  onan- 
ism  and  licentious  thoughts.  On  these  foundations  phobias  and 
scruples  arise  which  are  further  exaggerated  by  reading  books 
on  popular  medicine.  In  short,  in  the  hysterical  patient  the 


320  PSYCHIC   TREATMENT 

secret  of  helplessness  escapes  the  physician  as  well  as  the 
patient.  It  is  much  easier  to  carry  on  this  study  with  neur- 
asthenic subjects,  in  men  who  are  willing  to  confess. 

I  have  very  often  observed  troubles  with  micturition  which 
have  been  designated — unhappily,  according  to  my  opinion — by 
the  name  of  "  urinary  stuttering."  Some  young  men  of  fifteen 
to  twenty-five  years  of  age  find  it  impossible  to  pass  the  urine 
when  they  are  intimidated.  I  have  already  indicated  this 
difficulty  in  the  majority  of  men  when  they  are  asked  to 
urinate  during  consultation.  If  one  encourages  the  subject 
and  lets  him  alone,  this  wholly  mental  lack  of  power  can  easily 
be  overcome.  In  emotional  neuroses  micturition  becomes  im- 
possible if  it  has  to  be  performed  in  the  presence  of  another 
person.  One  sees  in  the  hospital  some  patients  who  are  unable 
to  urinate  in  the  open  ward. 

Many  of  my  neurasthenics  can  not  urinate  in  the  public 
urinals.  There  are  some  who  succeed  if,  by  chance,  they  are 
alone,  altho  the  fear  of  seeing  somebody  come  in  is  enough 
to  paralyze  them. 

These  young  people  are  usually  very  timid ;  they  are  some- 
times morally  chaste  and  excessively  modest,  but  often  they 
are  very  dissolute  in  thought,  and  only  virtuous  by  excess  of 
timidity  in  the  presence  of  women.  There  are  some  who, 
living  in  a  continual  erotic  erethism,  give  themselves  up  to 
masturbation.  They  have  read  pamphlets  on  the  consequences 
of  this  vice,  or  else  they  imagine  that  their  thoughts  can  be 
read  in  their  face.  These  preoccupations  begin  to  trouble  the 
mechanism  of  micturition.  One  of  my  patients  had  read  that 
onanism  can  lead  to  stricture,  and  knew  about  the  gimlet  jet 
of  patients  attacked  with  this  affection.  While  urinating  he 
fixed  his  attention  on  the  form  of  the  jet.  He  was  persuaded 
that  his  neighbors  observed  it.  He  detected  their  malicious 
smile,  and  micturition  became  impossible. 

The  mockery  of  school  comrades  has  often  provoked 
troubles  of  this  kind  in  very  young  boys,  but  they  appear 
more  often  toward  puberty,  at  the  time  when  the  young  man 
becomes  conscious  of  the  dual  urinary  and  genital  role  of 
his  organs. 


OF  NERVOUS   DISORDERS         321 

It  is  evident  that  the  treatment  of  these  phobias  can  not 
be  other  than  psychotherapeutic.  It  consists  in  giving  the 
patient  confidence  in  himself.  The  physician  ought  to  make 
himself  his  patient's  friend,  talk  to  him  as  a  comrade,  and 
make  him  understand  that  the  obstacle  is  purely  mental;  but 
practitioners  do  not  always  think  of  that.  They  seek  the  cause 
in  the  genito-urinary  organs,  recommend  perineal  douches, 
pass  refrigerent  catheters,  and  treat  the  bladder  with  elec- 
tricity. 

This  manner  of  proceeding  is  disastrous,  it  perverts  the 
patient's  mind  and  makes  him  hypochondriacal. 

Other  physicians,  set  in  their  ideas  of  original  sin,  make 
out  to  the  patient  that  his  licentious  preoccupations  are  crimi- 
nal, and  describe  to  him  in  an  exaggerated  way  the  conse- 
quences of  onanism,  and  create  a  regular  mania  of  scruples 
in  these  unfortunates. 

There  are  some  patients  in  whom  one  is  quickly  able,  by 
a  single  conversation,  to  dissipate  these  timidities  and  phobias 
and  the  whole  series  of  hypochondriacal  and  neurasthenic 
symptoms,  but  there  are  some  rebellious  cases.  Success  de- 
pends at  the  same  time  upon  the  more  or  less  firm  mentality 
of  the  subject  and  the  patience  which  he  throws  into  the 
pursuit  of  his  psychotherapeutic  work,  and  the  logic  which 
he  puts  into  his  choice  of  means.  I  can  not  repeat  often 
enough  that  local  treatment  only  compromises  the  result. 

Incontinence,  chiefly  nocturnal,  is  the  rule  in  early  infancy, 
and  mothers  know  how  to  overcome  it  efficaciously  by  edu- 
cation. This  incontinence  persists  in  nervous  and  unbalanced 
subjects  and  sometimes  constitutes  a  really  incurable  infirmity. 

Often,  however,  one  succeeds  in  curing  it,  but  this  result 
is  obtained  by  such  different  ways  that  I  had  recognized  the 
influence  of  the  suggestion  long  before  the  hypnotizer  had 
demonstrated  the  frequent  efficacy  of  their  proceedings. 

In  light  cases  one  can  attain  the  end  by  limiting  the 
liquid  food  at  the  evening  meal,  in  making  the  children  urinate 
at  a  later  hour,  at  the  time  when  the  parents  go  to  bed,  or 
even  by  interrupting  their  sleep  for  this  purpose  in  the  middle 
of  the  night.  It  is  thus  that  good  habits  are  created. 


322  PSYCHIC  TREATMENT 

The  use  of  belladonna  preparations  may  give  success,  but 
I  have  often  succeeded  with  such  medicines  as  iron,  even  when 
the  patient  was  not  anemic,  with  bicarbonate  of  soda  and 
hydrochloric  acid.  Others  use  electrization  of  the  neck  of 
the  bladder,  and,  in  a  girl  twenty  years  of  age,  I  cut  short 
the  incontinence  by  intra-urethral  faradization,  when  external 
application  on  the  abdomen  and  perineum  had  been  without 
results.  Was  there  a  true  action  on  the  part  of  the  medication 
and  the  electricity,  or  was  the  suggestion  the  only  thing?  I 
incline  toward  the  second  alternative. 

I  confess  that  until  now  I  have  not  had  very  clear  ideas 
on  the  genesis  and  nature  of  this  incontinence.  Is  it  due  to 
a  spasm  or  to  a  paresis?  Does  it  come  from  a  dream  under 
the  influence  of  mental  representations  in  the  way  that  seminal 
loss  follows  a  lascivious  dream?  In  the  present  state  of  our 
ignorance  it  is  difficult  to  use  a  wholly  rational  psychotherapy, 
and  much  more  so  when  it  concerns  children. 

This  is  one  of  those  exceptional  cases  where  I  would  not 
fear  to  have  recourse  to  hypnosis,  altho  the  attitude  of  the 
wonder-worker  that  one  has  to  take  is  so  repugnant  to  me 
that  it  brings  a  blush  to  my  cheeks  when  I  decide  to  use  it. 

These  considerations  do  not  apply,  I  hardly  need  say, 
to  idiopathic  nocturnal  incontinence,  and  not  to  that  which 
may  be  symptomatic,  and  sometimes  the  only  sign  of  epilepsy. 

Polyuria  is  frequent  among  nervous  people.  Every  one 
knows  the  abundant  and  clear  urine  of  spastic  contraction 
which,  in  nervous  women,  alternates  with  the  concentrated 
urine  of  oliguria. 

I  have  often  observed  in  simple  neurasthenics  a  transitory 
polyuria,  the  quantity  mounting  up  as  high  as  three  or  four 
quarts  in  twenty-four  hours.  It  has  seemed  to  me  to  lead 
to  a  favorable  prognosis,  and  I  have  always  seen  it  cease  in 
the  course  of  the  treatment  which  I  had  at  the  same  time 
applied  both  mentally  and  physically  to  these  conditions. 

It  is  not  at  all  the  same  with  the  persistent  polyuria  which 
is  designated  under  the  name  of  diabetes  insipidus.  The  pa- 
tients who  are  attacked  by  it  are  polydipsic  as  well  as  poly- 
uric,  without  its  being  possible  to  say  what  bond  united  these 


OF  NERVOUS   DISORDERS         323 

two  parallel  phenomena.  There  is  evidently  a  disturbance 
in  the  functions  of  nutrition,  and  the  fact  that  cranial  trau- 
matism  may  produce  this  malady  seems  to  indicate  the  cerebral 
origin  of  the  trouble.  In  the  cases  which  I  have  observed  I 
have  always  found  symptoms  of  mental  disequilibrium,  and 
even,  in  periods,  some  unquestionably  psychotic  conditions. 
My  efforts  to  cure  such  polyuria  have  been  in  vain. 

Psychotherapy  recovers  its  rights  in  pollakiuria.  This 
trouble  generally,  but  not  necessarily,  accompanies  polyuria; 
there  are  some  patients  whose  bladders  become  dilated,  and 
who  can  pass  large  quantities  of  urine  without  the  number  of 
micturitions  being  perceptibly  increased. 

But  when  one  observes  pollakiuria  without  palyuria,  and 
by  rigorous  clinical  examination  can  exclude  all  affection  of 
the  bladder,  of  the  urine,  or  of  the  kidneys,  it  is  necessary  to 
recognize  the  psychic  nature  of  the  trouble  and  to  treat  it  as 
such  by  advice. 

M.  W was  a  neurasthenic  twenty-eight  years  of  age, 

whom  I  treated  for  several  weeks  for  vertigo,  headaches,  pho- 
bias, and  a  transient  attack  of  melancholia.  He  was  on  the  road 
to  improvement,  when  one  day  he  announced  with  fright 
that  he  was  attacked  by  a  new  trouble  and  was  obliged  to 
urinate  from  eight  to  ten  times  in  the  course  of  the  night. 
Altho  I  had  already  had  some  suspicion  of  the  nature  of  this 
sudden  pollakiuria,  I  took  good  care  not  to  throw  out  the 
suggestion  that  the  trouble  was  nervous.  I  delayed  my  judg- 
ment, and  asked  the  patient  to  measure  the  quantity  of  urine 
which  he  passed  during  twenty-four  hours.  The  first  day 
he  went  as  high  as  1700  c.  c.,  and  on  the  second  to  1800.  I 
found  no  albumen,  sugar,  or  excess  of  phosphates;  it  con- 
tained no  abnormal  cellular  elements. 

Having  thus  duly  established  the  integrity  of  the  urinary 
organs,  I  made  this  speech  to  my  patient :  "  You  have  no  dis- 
ease of  the  bladder  or  of  the  kidneys,  and,  considering  your 
antecedents  and  the  manner  in  which  this  trouble  has  de- 
veloped, I  have  the  right  to  consider  it  as  nervous.  The 
human  bladder,  when  it  is  in  a  healthy  condition,  and  yours 
is  normal,  can  contain  about  300  c.  c.  of  urine  without  there 


324  PSYCHIC   TREATMENT 

being  any  imperious  need  of  urinating.  You  pass  a  little  more 
than  1800  c.  c.  a  day — that  is  to  say,  slightly  more  than  in  a 
normal  condition,  by  reason  of  the  overfeeding  which  you 
practise.  Therefore,  1800  divided  by  300  gives  6;  you  have 
the  right  to  urinate  six  times  in  twenty-four  hours,  or,  if  you 
like,  five  times  in  the  day  and  once  at  night !  " 

"  But,"  replied  the  patient,  "  you  are  very  good  to  say  to  me 
'  You  have  the  right ! '  But  when  I  am  obliged  to  urinate  ten 
times,  what  can  I  do  about  it,  and  where  does  this  strange 
difficulty  come  from  ?  " 

"  My  dear  sir,  if  you  urinate  so  often  it  is  because  you  think 
about  it !  You  have  once — by  chance,  perhaps — been  awakened 
by  the  need  of  urinating,  and,  with  your  uneasy  mind,  you 
have  been  asking  yourself  what  was  the  matter.  Your  atten- 
tion has  been  bearing  on  this  trifling  disorder;  it  has  become 
an  expectant  attention.  Now,  nothing  gives  rise  to  the  need 
of  urinating  like  thinking  about  it.  Get  it  into  your  head  that 
there  is  nothing  diseased  about  it  and  you  will  pass  your  urine 
as  everybody  else  does — five  or  six  times  a  day !  " 

The  next  morning  my  patient  received  me,  exclaiming: 
"  That's  all  right !  I  have  urinated  five  times  in  the  day  and 
once  at  night.  I  even  wanted  to  suppress  this  nocturnal 
evacuation  which  troubles  my  rest ! " 

"  Good !  "  I  replied.  And  from  that  time  on  the  pollakiuria 
has  never  reappeared. 

The  patient  furnished  me,  at  the  end  of  his  cure,  with  a 
very  typical  example  of  what  the  moral  attitude  could  do  in 
neurasthenic  states.  He  had  been  going  out  for  a  few  days, 
and  seemed  to  be  a  little  timid  in  his  walks.  I  thought  I  ought 
to  try  to  get  him  to  make  more  effort,  and  I  advised  him  to 
go  to  town  and  visit  a  museum.  It  was  very  warm  that  day, 
and  I  could  not  help  but  ask  myself  if  the  prolonged  walk 
would  not  bring  on  some  nervous  troubles.  I  hesitated  to 
draw  the  patient's  attention  to  the  possibility,  in  the  fear  of 
suggesting  discomfort  to  him.  On  the  other  hand,  it  seemed 
to  me  imprudent  to  let  him  go  without  having  braced  up  his 
attitude. 

"  Go,"  I  said  to  him,  "  and  if  you  are  taken  with  any 


OF  NERVOUS   DISORDERS         325 

discomfort,  such  as  dizziness  or  headaches  or  uneasy  feelings, 
I  count  on  your  strength  to  rise  above  such  trifles." 

"  Have  no  fear,"  said  he,  with  assurance,  "  I  shall  know 
how  to  get  over  that !  " 

The  next  morning  I  found  him  in  very  good  spirits,  and 
he  related  what  follows :  "  Yesterday,  according  to  your  ad- 
vice, I  went  to  town,  and  for  the  first  hour  all  went  very  well ; 
but  when  I  had  to  pass  over  a  bridge  I  was  taken  with  dizzi- 
ness, a  sort  of  indefinable  discomfort,  and  it  took  a  good  deal 
of  courage  to  continue.  This  was  still  worse  when  I  entered 
the  historical  museum.  I  was  seized  with  all  the  troubles  of 
which  I  complained  before  my  treatment.  Suddenly  I  felt 
myself  bored  and  sad  and  ready  to  weep;  I  felt  a  sense  of 
pressure  in  my  head;  the  dizziness  became  unbearable,  and  I 
was  going  to  go  out  without  having  visited  the  museum,  when 
my  eyes  fell  on  a  flag  which  bore  on  the  arms  of  a  white  cross 
these  words  in  letters  of  gold :  '  Honor  to  courage,  to  weak- 
ness, shame ! '  'Ah,  yes ;  to  weakness  shame ! '  I  cried,  and  as 
if  by  enchantment  all  my  discomforts  disappeared.  I  was  able 
to  visit  the  rest  of  the  museum  and  to  take  that  long  walk 
home  in  very  good  condition  and  proud  of  my  success." 

The  patient  remained  cured  and  has  never  had  occasion  to 
put  into  execution  the  advice  which  I  then  gave  him.  "  If 
ever  you  are  taken  with  these  troubles,  think  of  the  magic 
flag,  and  you  will  be  cured !  " 

The  following  year  I  had  occasion  to  observe  a  new  case 
of  this  nervous  pollakiuria.  It,  likewise,  came  about  suddenly 
in  a  neurasthenic  patient  who  was  much  improved  by  the 
Weir  Mitchell  treatment,  and  when  he  was  still  in  bed,  en- 
joyed physical  and  moral  rest.  It  was  enough  for  me  to 
relate  my  observations  on  the  patient  which  I  have  just  de- 
scribed to  reduce  the  micturitions  to  the  normal  number. 

The  qualitative  modifications  of  the  urine  have  no  impor- 
tance in  the  diagnosis  or  prognosis  of  the  psychoneuroses. 
They  do  not  throw  the  slightest  light  on  the  pathogeny  of  the 
symptoms.  These  variations  in  the  chemical  composition  of 
the  urine  are  wholly  secondary  and  due  to  innumerable  func- 
tional disorders  which  result  from  anorexia  and  insufficient 


326  PSYCHIC  TREATMENT 

or  defective  food;  sometimes  from  boulimia,  or  diarrhea,  or 
constipation. 

The  inversion  of  the  formula  of  the  phosphates  is  not 
sufficient  as  a  characteristic  upon  which  a  diagnosis  of  hys- 
teria can  be  based.  It  is  only  a  minor  detail  among  the 
functional  disturbances  of  the  major  psychoneuroses. 

Phosphaturia  is  frequent  among  neurasthenics,  and  it  is 
often  so  marked  that  the  urine  comes  frothing  from  the 
urethra.  I  have  not  yet  been  able  to  determine  exactly  if 
this  is  a  question  of  a  real  excess  of  phosphates,  or  if  it  be  only 
an  abnormal  precipitation  by  virtue  of  the  chemical  reaction 
of  the  urine.  In  all  the  patients  whom  I  have  examined  the 
fresh  urine  presents  a  more  or  less  alkaline  reaction,  explain- 
ing the  phosphatic  deposit,  without  which  there  would  have 
been  reason  to  admit  a  superabundance  of  phosphates.  As  to 
the  deposits  of  urates,  they  are  formed  more  often  merely  by 
the  chilling  of  the  concentrated  urine,  and  it  is  a  pity  that 
so  many  physicians  lay  so  much  stress  on  a  red  sediment  and 
give  their  neurasthenic  patients  another  new  phobia,  that  of 
uric  acid  gravel. 

I  have  observed  in  weak  and  tired  neurasthenics  slight 
albuminuria  without  casts  and  without  cellular  elements.  They 
have  been  cured  by  rest  and  strengthening  food.  I  have  also 
been  able  to  detect  the  influence  of  overwork,  chiefly  intel- 
lectual, on  alimentary  glycosuria.  The  quantity  of  sugar  in- 
creases in  the  periods  of  fatigue. 

But  these  are  consequences  of  the  least  importance  to 
nervousness.  These  chemical  troubles  of  nutrition  generally 
yield  to  the  action  of  physical  modes  of  treatment,  rest,  or, 
on  the  contrary,  suitable  gymnastics,  and  rational  food.  The 
moral  condition,  by  the  effect  which  it  has  upon  the  function- 
ing of  the  body,  also  acts  on  these  disorders. 

In  short,  the  urology  of  the  psychoneuroses  has  not  yet 
been  made,  and  it  will  not  be  so  long  as  one  limits  one's  self 
to  superficial  examinations  which  often  do  not  even  extend 
over  the  quantity  of  urine  voided  in  twenty-four  hours,  and 
in  which  no  count  is  taken  of  the  patient's  diet.  It  is  even 
probable  that  the  examination  of  the  urine  will  never  be  any- 


OF  NERVOUS   DISORDERS         327 

thing  other  than  of  trifling  importance,  and  will  only  reveal 
secondary  troubles.  It  is  only  throwing  dust  in  the  patient's 
eyes,  in  cases  of  nervousness,  to  have  the  pharmacists  make  a 
detailed  analysis,  as  if  this  examination  was  going  to  throw 
light  upon  the  cause  of  the  trouble. 

A  still  closer  connection  is  established  between  the  psy- 
choneuroses  and  the  sexual  life,  and  if  patients  were  a  little 
less  discreet  on  this  point  we  should  see  that  there  is  very 
little  "  nervousness  "  in  those  who  have  no  sexual  disturbances. 

We  have  seen  that  in  the  animal  the  venereal  orgasm  has 
the  character  of  a  violent  nervous  crisis  and  of  an  emotional 
movement.  In  the  rutting  time  the  animal  changes  its  char- 
acter; it  undergoes  a  passional  crisis,  and  one  knows  how 
much  castration  modifies  the  mentality  of  the  domestic  ani- 
mals. In  man  this  particular  functioning  is  less  physiological. 
His  desires  no  longer  awaken  at  regular  periods,  under  the 
sole  influence  of  the  internal  workings  of  his  organs  of  gener- 
ation ;  they  flare  up  with  the  greatest  facility  by  a  play  of  the 
imagination. 

I  must  send  you  to  special  works  for  the  description  of 
the  multiple  aberrations  of  the  sexual  instinct  which  have 
been  summed  up  under  the  name  of  "  psychopathia  sexualis." 
In  sadism,  masochism,  sodomy,  and  tribadism  the  organic 
functions  may  be  normal;  the  disorder  is  purely  psychic  and 
moral.  We  are  in  the  territory  of  psychiatry. 

The  prognosis  of  these  psychopathies  is  very  unfavorable. 
One  finds  in  the  majority  of  these  subjects  a  complete  absence 
of  morality  against  which  it  is  useless  to  struggle.  Other  pa- 
tients, nevertheless,  suffer  from  their  slavery  and  are  more 
or  less  accessible  to  moral  treatment.  In  short,  in  lesser  de- 
grees the  trouble  diminishes.  It  seems  to  be  nothing  more 
than  an  immorality  which  has  formed  at  puberty  or  some  time 
in  adult  age  certain  vicious  habits,  and  it  becomes  easy  for 
the  physician  who  knows  how  to  make  a  friend  of  his  patient 
to  put  him  on  the  right  road.  Under  these  mild  forms  pe- 
culiarities abound  in  sexual  life,  and  it  is  not  easy  to  trace 
the  boundary  between  the  normal  exercise  of  the  sexual  func- 
tion and  libertinism. 


328  PSYCHIC  TREATMENT 

The  onanism  practised  with  frenzy  in  childhood,  persist- 
ing to  adult  age  in  married  men  or  in  those  who  are  able  to 
exercise  normal  sexual  functions,  is  a  symptom  of  mental 
disequilibrium.  There  are  some  who  even  have  nocturnal 
pollutions  which  continue  in  conditions  when  the  need  is  nor- 
mally satisfied.  This  erethism  is  pathological.  The  fatigue 
which  results  from  these  excesses  or  from  nocturnal  losses 
aggravates  the  mental  condition  of  the  patient.  There  is  thus 
established  a  vicious  circle. 

On  the  contrary,  onanism  in  the  child  at  the  beginning  of 
puberty  is  almost  normal.  I  have  read  somewhere  that  a 
German  physician  had  made  statistical  study,  and  had  found 
onanism  in  ninety-nine  per  cent,  of  boys.  Now,  our  neigh- 
bors beyond  the  Rhine  are  not  notorious  for  vice,  and  this 
result  deserves  consideration.  It  is  not  astonishing  if  one 
considers  that  desires  awaken  at  an  age  when  reason  is  not 
yet  formed,  often  even  long  before  the  establishment  of  the 
spermatic  function.  These  habits  generally  disappear  in  the 
young  man,  whether,  by  following  the  easy  morals  of  the 
world,  he  falls  between  Scylla  and  Charybdis  by  going  with 
women,  or  marries  young,  or  whether,  in  short,  being  better 
endowed  morally,  he  knows  enough  to  give  up  disgusting 
habits  and  remain  chaste  even  when  his  position  may  delay 
the  period  of  his  marriage  or  forbid  it. 

Far  be  it  from  my  thought  to  deny  that  sexual  excesses  or 
onanism  have  no  effect  upon  the  health.  Nothing  weakens 
the  organism  like  the  frequent  repetition  of  this  nervous 
crisis.  A  neurasthenic  condition  follows  this  outbreak:  omnc 
animal  post  coitum  triste.  .  It  is  not  rare  to  come  across 
neurasthenics  who  are  incapable  of  bearing  the  consequences 
of  the  sexual  act.  It  seems  to  exhaust  the  reserve  of  their 
nervous  capital. 

On  the  other  hand,  the  moderate  exercise  of  the  sexual 
functions  can  create  a  salutary  euphoria  and  calm  the  nerves, 
even  in  sick  people;  it  favors  sleep,  and  sometimes  causes 
painful  mental  states  of  anxiety  and  vague  unrest  to  cease. 
There  are  some  physicians  who  conclude  from  this  that  con- 
tinence is  unhealthy,  and  I  have  seen  them  advise  young  neur- 


OF  NERVOUS   DISORDERS          329 

asthenics  of  sixteen  and  seventeen  years  of  age  to  have  con- 
nection with  women.  That  was  their  treatment  of  a  psycho- 
neurosis  ! 

The  chastity  of  priests  worthy  of  the  name  shows  us  that 
continence  has  no  dangers,  and  there  are  more  neurasthenics 
among  those  who  allow  free  course  to  their  sensuality  than 
among  those  who  know,  for  altruistic  or  moral  reasons,  and 
for  as  long  as  these  emotions  exist,  how  to  escape  from  the 
yoke  of  animalism. 

A  just  respect  for  feminine  modesty  prevents  the  physi- 
cian from  collecting  exact  data  concerning  the  erotic  life  of 
women.  I  am  led  to  believe  that,  consciously  or  unconscious- 
ly, women  submit  to  this  yoke  more  often  than  they  think, 
and  that  sensual  preoccupations — often  very  vague,  I  admit — 
play  a  role  in  the  development  of  their  nervousness. 

But  if  I  recognize  the  pathogenic  influence  not  only  of 
excesses  but  even  of  conscious  or  subconscious  erotic  mental 
representation,  I  can  not  protest  enough  against  its  exagger- 
ations. There  are  some  physicians  who  seem  to  take  a  las- 
civious pleasure  in  spying  out  these  weaknesses  and  putting 
indiscreet  questions  to  their  patients.  It  is  chiefly  in  hys- 
teria that  they  are  pleased  to  scrutinize  the  intimate  life  of  their 
patients.  Do  not  these  physicians  lend  to  their  patients  some- 
thing of  their  slightly  salacious  mentality? 

Many  neurasthenics  attribute  the  troubles  with  which  they 
are  afflicted  to  the  habits  of  onanism  which  they  practised 
in  childhood.  They  have  more  often  gotten  this  idea  from  the 
numerous  books  that  are  published  on  the  dangers  of  mastur- 
bation by  well-meaning  but  incompetent  people  or  by  charla- 
tans. It  is  in  these  patients  that  one  so  often  observes  psychic 
sexual  impotence  which  is  the  most  common  of  all  the  troubles. 
Timorous  or  doubtful  of  themselves,  they  approach  the  sexual 
relation  in  an  emotional  state  which  renders  it  impossible. 
The  ejaculation  is  often  premature ;  the  erection  remains  in- 
complete or  ceases  too  quickly.  One  sometimes  finds  that 
this  impotence  is  established  later  in  life  in  married  men  and 
in  fathers  of  a  family. 

I  do  not  hesitate  in  all  these  cases  to  boldly  dispel  the 


330  PSYCHIC  TREATMENT 

patient's  fears.  He  must  learn  to  pass  a  sponge  over  his 
past  and  wipe  out  his  phobias.  I  show  him  that  he  has  only 
become  sexually  neurasthenic  and  powerless  from  the  day 
when  he  read  some  pamphlet  on  this  subject,  or  since  he  al- 
lowed some  useless  remorse  to  become  fixed  in  his  heart. 
I  dare  tell  him  that  his  old  mistakes  to  which  he  must  not 
return  mean  nothing  at  all  in  his  condition.  It  often  happens 
to  me  that  I  am  thus  enabled  to  raise  my  patient's  courage  in 
a  single  conversation  and  to  give  him  this  healthy  confidence 
in  his  success,  which  is  so  necessary  in  all  that  he  undertakes ; 
for  the  amorous  undertaking,  however  natural  it  may  be,  is 
none  the  less  difficult. 

Psychic  powerlessness  occurs  as  the  result  of  other  mental 
representations.  One  sees  it  following  all  untimely  emotions; 
it  occurs  often  slightly  between  lovers,  sudden  remorse  arising 
on  account  of  an  infidelity  or  an  unpleasant  memory;  spite 
caused  by  visible  indifference  in  one  of  the  interested  parties. 
It  is  of  no  use  to  throw  a  stream  of  cold  water  on  the  in- 
cendiary who  has  lighted  the  fire.  I  have  seen  this  helpless- 
ness established  in  a  husband  who  had  to  accompany  his  wife 
to  the  gynecologist  and  who  had  found  the  postures  which 
he  saw  there  rather  lacking  in  estheticism.  The  charm  was 
broken. 

I  have  also  detected  in  these  impotent  people  other  signs 
of  nervousness.  They  are  chiefly  impressionable  people  in- 
capable of  resisting  their  first  feeling  and  of  correcting  their 
autosuggestion.  They  are  timid  people  who  doubt  themselves 
and  who  believe  themselves  in  every  domain  to  be  unequal  to 
their  duty. 

On  the  other  hand,  I  have  found  incurable  impotence  due 
to  total  absence  of  genetic  sense  more  compatible  with  psychic 
health.  There  are  men  who  have  never  had  an  erection,  nor 
even  a  seminal  discharge.  These  unfortunates  do  not  often 
perceive  their  infirmity,  and  I  have  known  several  who  have 
married  in  order  to  have  the  joys  of  a  family  and  have  not 
discovered  until  then  that  they  were  incurably  impotent.  This 
condition  often  accompanies  aspermia  and  enters  rather  into 
the  class  of  somatic  degeneracies. 


OF  NERVOUS   DISORDERS         331 

In  women,  in  spite  of  their  frigidity,  due  in  great  part  to 
the  education  which  they  get  between  themselves,  the  regular 
exercise  of  the  sexual  functions  and  maternity  seem  to  exercise 
a  good  influence  on  the  health.  One  more  often  finds  the 
conditions  of  psychoneuroses  in  unmarried  women.  But  it  is 
difficult  to  say  what  belongs  to  continence,  to  the  non-satis- 
faction of  natural  needs,  and  what  depends  upon  the  abnormal 
conditions  of  life,  due  to  the  normal  isolation  in  which  they 
live  as  celibates.  In  woman,  as  in  man,  conjugal  life  is  a  con- 
dition of  health  and  longevity.  On  the  other  hand,  many 
women  only  find  misfortune  in  marriage  and  owe  their  nerv- 
ousness to  the  sufferings  which  they  undergo.  There  is  too 
much  to  be  said  on  both  sides  for  the  physician  to  be  able  to 
advise  marriage  as  a  therapeutic  measure,  or,  on  the  other 
hand,  to  oppose  a  projected  union,  by  setting  forth  the  nerv- 
ousness of  one  of  the  contracting  parties  as  an  obstacle.  Cupid, 
moreover,  would  seem  to  be  as  deaf  as  he  is  blind,  and  our 
patients  would  scarcely  listen  to  us  in  such  an  emergency. 

Menstruation  is  of  all  the  functions  of  the  feminine  or- 
ganization that  which  acts  the  most  on  the  mentality.  Nearly 
all  women  suffer  in  these  days  from  nervous  troubles,  cephal- 
algias,  rachialgias,  and  general  fatigue.  But  the  most  strik- 
ing thing  is  the  psychic  condition,  and  one  sees  the  appearance, 
even  among  healthy  women,  of  the  mental  stigmata  of  the 
psychoneuroses. 

A  woman  under  the  influence  of  her  periods  is  more  easily 
tired  and  more  sensitive,  more  emotional  and  more  a  prey 
to  her  autosuggestions  than  in  the  normal  condition.  Her 
tears  flow  more  easily;  she  is  less  able  to  bear  annoyances; 
she  is  more  susceptible,  and  one  often  finds  in  her  a  spirit  of 
contradiction  which  she  does  not  show  at  any  time  except 
during  the  menstrual  period. 

The  normal  woman  is  really,  during  the  time  that  this 
function  lasts,  a  psychoneurotic.  If  she  is  ordinarily  nervous 
she  becomes  still  more  so,  and  among  those  who  are  predis- 
posed one  sees  the  occurrence  of  menstrual  psychoses.  The 
prognosis  may  be  very  severe,  and  there  are  women  who  could 
be  shut  up  every  month  in  an  insane  asylum.  However,  I 


332  PSYCHIC  TREATMENT 

have  observed  several  cases  of  menstrual  psychoses  in  which 
I  have  been  able  to  obtain  good  results  by  a  psychotherapic 
treatment,  by  developing  in  the  patients  their  altruistic  ten- 
dencies and  leading  them  to  be  mistresses  of  themselves. 

The  age  of  development  is  dangerous  for  young  girls. 
The  mental  conditions  of  neurasthenia  and  hysteria  occur 
easily  at  that  time,  but  may,  fortunately,  be  transient.  Some- 
times, however,  the  intimate  organic  work  which  takes  place 
at  this  age  gives  rise  to  very  serious  conditions  of  disequi- 
librium. One  often  then  sees  a  daughter  lose  the  intel- 
lectual vivacity  which  she  had,  become  awkward,  clumsy,  and 
crush  the  hopes  which  had  been  founded  on  her  abilities. 
It  possibly  is  due  to  analogous  influences  connected  with  the 
age  of  development  (dementia  prsecox,  so  often  confused  at 
the  beginning  with  neurasthenia). 

The  menopause  is  still  more  pathogenic,  and  there  are  few 
women  who  escape  disturbances  and  various  functional  troub- 
les at  this  critical  age.  In  many  their  character  is  changed; 
they  become  difficult  to  please  and  sharp-spoken,  and  perhaps 
it  is  to  this  reason,  in  part,  that  one  must  attribute  the  bad 
reputation  which  in  every  country  is  given  to  a  great  many 
mothers-in-law.  When  their  children  marry  they  are  usually 
in  this  fretful  period. 

It  is  also  the  age  when  one  sees  the  beginning  of  hypo- 
condriacal  and  melancholic  conditions,  accompanied  by  strange 
sensations  of  osmatic  appearance — hot  flashes  extending  over 
the  entire  body;  widely  distributed  pains  which  grow  worse 
at  night ;  intense  prickings  in  the  mouth  and  the  throat ;  burn- 
ing sensations  in  the  stomach,  etc. 

It  seems  that  it  is  not  only  the  more  or  less  abrupt 
cessation  of  the  menstrual  function  which  determines  these 
symptoms,  but  the  woman  enters  at  the  same  time  into  another 
period  of  age :  she  takes  one  step  further  toward  senility.  One 
sees  the  same  thing  happening  among  men,  toward  the  fifth 
decade,  and  it  is  not  without  reason  that  they  speak  of  a 
masculine  menopause,  even  when  there  is  no  suppression  of 
any  function.  One  must  not  forget  that  organic  decadence 
begins,  in  fact,  very  soon  after  the  thirties.  It  is  continued, 


OF  NERVOUS   DISORDERS         333 

but  it  seems  as  tho  by  periods  it  went  forward  in  such  a  way 
as  to  abruptly  modify  the  personality.  We  pass  by  the  crit- 
ical period  which  makes  us  more  vulnerable.  I  have  observed 
in  women  who  have  reached  the  fifties  the  whole  procession 
of  troubles  attributed  to  the  menopause — that  is  to  say,  to 
suppression  of  function;  but  these  women  had  seen  their 
courses  cease  some  years  before,  and  had  not  then  experienced, 
except  some  discomfort,  any  serious  trouble.  Ovariotomy, 
which  suppresses  the  function  in  women  who  are  still  young, 
does  not,  as  a  rule,  produce  the  nervous  troubles  of  the  critical 
age.  It  thus  seems  natural  to  me  to  attribute  to  the  age  itself 
an  etiological  influence. 

In  spite  of  their  distinctly  somatic  origin,  these  psycho- 
neuroses  connected  with  the  sexual  life  or  phenomena  of 
senility  are  still  amenable  to  a  rational  psychotherapy.  One 
must  not  neglect  material  means.  Rest  and  isolation  from 
the  family  circle  are  often  necessary.  One  must  study  the 
patient's  constitution,  and  overcome  her  diathetic  states  by  an 
appropriate  regime,  and  lead  her  back  by  wholesome  and 
frugal  diet  to  the  establishment  of  good  habits  of  life.  But 
these  patients  have  at  the  same  time  need  of  good  advice. 
By  a  sensible  word  they  will  modify  their  mentality  in  spite 
of  the  unknown  mysterious  organic  causes  which  disturb  it. 


334  PSYCHIC  TREATMENT 


CHAPTER   XXVI 

Troubles  with  Sleep  —  The  Uselessness  and  Dangers  of  Narcotic  Medi- 
cation —  The  Insufficiency  of  Various  Kinds  of  Hydrotherapy  — 
Efficacy  of  Psychotherapy  —  Causes  of  Insomnia:  Physical  Ones, 
Too  Vivid  Sensorial  Impressions ;  Moral  Ones,  Intoxications  and 
Autointoxications;  Preoccupations  or  Obsessions  —  Anxiety  in  Try- 
ing to  Get  to  Sleep — Psychotherapeutic  Machinery — Creation  of  a 
Mental  Condition  Favorable  to  Sleep  —  Abuse  of  Medicinal  and 
Hydrotherapic  Treatment 

AMONG  the  symptoms  of  the  psychoneuroses  there  is  one 
of  great  importance  by  reason  of  its  frequency  and  the  aggra- 
vation that  it  causes  in  the  patient's  condition.  This  is  in- 
somnia. The  majority  of  patients  suffering  from  nervousness 
sleep  badly,  but  their  insomnia  appears  under  very  different 
forms.  There  are  patients  who  get  to  sleep  with  difficulty. 
They  go  to  bed  tired,  but  when  they  are  in  bed  sleep  does 
not  come.  Some  recognize  the  fact  that  they  are  kept  awake 
by  obsessions  which  they  try  in  vain  to  get  rid  of.  Others 
state  that  their  thoughts  are  not  fixed  on  any  disturbing  sub- 
ject, but  that  they  can  not  fall  asleep.  Certain  patients  fall 
asleep  easily,  but  they  wake  up  at  the  end  of  a  few  hours  and 
can  not  get  to  sleep  again;  many  fall  asleep  toward  morn- 
ing, at  the  hour  when  they  ought  to  get  up. 

During  these  hours  of  insomnia  the  mental  condition  of 
the  patient  is  very  variable.  I  have  seen  some  who  do  not 
suffer  at  all.  They  admit  coolly  that  they  do  not  sleep,  but 
they  do  not  experience  any  unpleasant  sensation.  Others  be- 
come impatient  and  grow  vexed.  They  turn  over  incessantly 
in  bed,  get  up,  and  go  back  to  bed  again.  There  are  neur- 
asthenics who  have  melancholic  insomnia.  When  it  is  dark 
everything  looks  black  to  them ;  they  look  upon  their  position 
in  the  world  in  a  pessimistic  way.  Sometimes  they  take  ac- 


OF  NERVOUS   DISORDERS         335 

count  of  their  life  from  a  selfish  point  of  view  and  grieve  over 
their  failures  and  the  vicissitudes  of  their  existence.  Often, 
however,  they  are  high-minded  souls  in  whom  altruistic 
thoughts  predominate.  Their  life  appears  ugly  to  them;  it 
is  not  worth  the  trouble  to  live  it;  it  is  but  a  vale  of  tears. 
If  they  are  intellectual  their  preoccupations  are  philosophic. 
They  live  in  this  psychic  discomfort  which  the  pessimistic 
philosophers  have  so  ably  described.  They  mingle  religious 
aspirations  with  them,  without  being  able  to  attain  the  faith 
which  would  save  them.  And,  lastly,  many  find  their  insomnia 
caused  only  by  the  pains  which  they  suffer,  their  dyspeptic 
troubles,  their  eructations  and  belchings,  and  by  various  pain- 
ful sensations  such  as  palpitation  and  anguish.  It  seems  to 
them  as  tho  they  could  go  to  sleep  if  they  could  be  relieved 
of  all  these  discomforts.  Let  us  note,  finally,  the  patients  who 
sleep,  but  with  agitated  sleep,  disturbed  by  dreams  and  night- 
mares. Sometimes  they  preserve  no  memory  of  the  dream, 
but  are  conscious  of  having  had  an  interrupted  and  disturbed 
sleep,  and  they  state  in  the  morning  that  they  have  not  rested 
well. 

Insomnia  of  a  slightly  melancholic  form  accompanied  by 
preoccupying  obsessions  is  very  distressing,  but  I  can  say  that 
it  is  less  serious.  It  is  often  seen  in  people  who  have,  it  is 
true,  the  neurasthenic  mentality,  but  who  recover  their  psychic 
equilibrium  so  well  by  day  that  they  are  never  interrupted 
in  their  activity.  They  are  not,  properly  speaking,  sick.  They 
are  nervous,  sensitive,  emotional,  and  often  have  delicate  souls 
which  are  chilled  by  the  horrors  of  life.  In  this  limited  sense 
neurasthenia  is  more  like  a  personal  characteristic  which  they 
must  put  up  with. 

I  consider  more  severe  the  persistent  insomnia  of  certain 
patients  who,  during  weeks  and  months,  lie  awake  all  night 
without  being  able  to  indicate  what  has  troubled  them.  It  is 
with  such  patients  that  one  also  observes  peculiar  troubles  of 
psychic  or  physical  sensibility.  There  are  some  who  like  gray 
weather  and  rain,  and  who  fear  fine  weather;  even  in  winter 
they  are  apprehensive  of  the  return  of  spring. 

In  others  one  detects  an  incredible  indifference  to  cold 


336  PSYCHIC   TREATMENT 

or  pain.  This  recalls  the  insensibility  of  insane  people  who 
mutilate  themselves.  These  are  unbalanced  people,  agitated 
persons,  who  react  in  an  abnormal  way;  they  are  on  the 
borderland  of  insanity. 

Finally,  sleep  may  be  disturbed  by  dreams  or  nightmares. 
This  agitation  is  frequent  in  the  hysterical  and  in  that  kind 
of  nervousness  which  is  only  skin  deep,  but  which  seems  to 
be  the  normal  condition  of  many  women. 

What  can  one  do  against  these  various  forms  of  insomnia? 
One  gives  medicines,  narcotics,  sulphonal,  trional,  paraldehyde, 
bromide,  and,  lastly,  chloral  or  opium,  or  preparations  whose 
composition  we  do  not  know.  It  is  very  simple.  Well,  I 
confess,  without  shame,  that  during  twenty  years  I  have  not 
had  occasion  to  prescribe  any  of  these  remedies. 

I  have,  and  with  good  cause,  a  mediocre  confidence  in  the 
solidity  of  the  cortical  layer  of  the  brain.  Its  cells  seem  to 
be  very  fragile,  and  I  feel  certain  scruples  about  introducing 
into  the  blood  current  any  such  stupefying  drugs  which  pro- 
duce sleep.  It  is  a  true  intoxication  which  is  brought  on  and 
it  has  to  do  with  the  most  delicate  parts — the  thinking  organ. 
I  only  employ  them,  and  then  with  repugnance,  in  people  who 
are  normal  from  the  mental  point  of  view  and  when  the  need 
of  suppressing  pain  is  indicated.  I  fear  their  use  among  my 
patients  who  are  psychically  weak.  Such  intervention  ap- 
pears dangerous  to  me,  and  I  can  not  forget  that  its  salutary 
effect  can  only  be  transient,  for  all  these  drugs  which  are 
foreign  to  the  normal  chemistry  of  the  organism  are  rapidly 
eliminated  by  the  various  emunctories. 

I  would  have  recourse,  perhaps,  to  these  narcotics  if  I 
were  persuaded  of  their  efficacy,  but  I  have  good  reasons  to 
doubt  it.  My  patients  are  all  chronic,  and  if  they  have  al- 
ready exhausted  these  medications  without  success,  they  are 
just  where  they  were  before.  There  are  some  who  preserve 
some  confidence  in  these  means  and  renounce  with  much  diffi- 
culty any  temporary  relief  that  they  may  obtain  from  them, 
but  I  find  many  others  who  are  already  converted  and  heave 
a  sigh  of  relief  when  I  tell  them  that  I  will  not  prescribe  any 
medicine  to  make  them  sleep. 


OF  NERVOUS   DISORDERS         337 

I  have  had  from  the  beginning  of  my  career  this  fear  of 
narcotics  which  I  consider  reasonable,  but  which  others  may 
consider  merely  a  sentimental  phobia.  I  have  sought  to  re- 
place them  by  the  more  anodyne  processes  of  bathing — warm 
baths,  compresses,  foot-baths,  etc.  Sometimes  I  have  ob- 
tained good  results.  But  am  I,  perhaps,  too  skeptical?  They 
have  not  been  sufficiently  constant  to  encourage  me  in  this 
way.  I  have  thrown  the  helve  after  the  blade  and  since  then 
I  have  kept  to  pure  psychotherapy. 

When,  on  the  basis  of  my  observations  at  the  bedside  of 
a  patient,  I  have  reflected  on  the  pathogeny  of  insomnia  and 
of  sleep  disturbances  caused  by  dreams,  I  have  reached  the 
following  conclusions :  Sleep  may  be  troubled  by  too  vivid 
sensorial  impressions,  pains,  physical  discomforts,  noise,  and 
light.  We  ordinarily  eliminate  these  sensorial  excitations,  and, 
as  for  pain,  I  think  that  one  must,  before  all,  try  to  suppress 
the  cause  before  having  recourse  to  palliatives.  The  use  of 
morphine  is  always  indicated  for  violent  pains,  especially  if 
the  affection  which  causes  it  is  transient.  One  must  be 
more  chary  of  it  when  the  trouble  is  chronic,  for  the  patient 
then  runs  the  risk  of  becoming  a  morphinist.  This  consider- 
ation ought  to  be  forgotten  when  it  is  a  question  of  an  incur- 
able disease,  and  morphine  may  then  be  largely  employed  to 
cause  euthanasia. 

When  sensibility  to  noise  is  exaggerated  and  is  shown  in 
the  presence  of  inevitable  noise,  one  must  not  forget  that  this 
hyperesthesia  is  wholly  psychic  and  ought  to  be  combated  by 
psychotherapic  measures.  I  will  return  to  this  later. 

Insomnia  may  result  from  the  absorption  of  substances 
which  act  directly  upon  the  brain,  such  as  tea  or  coffee;  per- 
haps sometimes  it  may  be  due  to  the  abuse  of  tobacco.  It  is 
easy  to  suppress  these  substances,  especially  in  the  evening 
meal.  But  here  again  it  is  good  not  to  forget  that  autosug- 
gestion is  always  possible. 

Analogous  effects  are  produced  by  autointoxications  re- 
sulting from  various  diseases,  chiefly  renal  affections  which 
lead  to  an  incomplete  purification  of  the  blood  and  to  uremia. 
The  first  step  is  to  suppress  the  cause  by  reestablishing  suffi- 


338  PSYCHIC  TREATMENT 

cient  diuresis,  but  often  we  are  forced  to  have  recourse  to 
narcotics. 

Apart  from  these  physical  causes  of  insomnia,  too  vivid 
sensorial  impressions,  intoxications,  and  autointoxications, 
I  see  no  other  physical  causes  explaining  insomnia,  and  this 
is  why,  in  the  immense  majority  of  cases,  I  resort  with  suc- 
cess to  psychic  treatment. 

It  consists  in  suppressing  the  mental  conditions  which 
prevent  sleep  and  in  establishing  that  calmness  of  mind  which 
alone  can  lead  to  what  we  call  the  sleep  of  the  just,  or,  rather, 
the  sleep  of  the  calm  man. 

The  preoccupations  which  lead  to  insomnia  are  legion, 
and  there  are  no  two  patients  to  whom  one  can  give  the  same 
advice.  When  these  are  true  misfortunes,  such  as  the  loss 
of  a  personal  friend,  real  cares,  and  a  justifiable  remorse  which 
haunts  the  mind  of  the  patient,  it  is  scarcely  possible  to  dispel 
the  sad  obsession.  However,  sympathy  consoles  and  time 
works  to  efface  these  impressions.  In  the  very  interest  of  the 
patient  one  must  know  how  to  wait  and  not  to  have  recourse 
to  palliatives  which  can  not  act  on  the  cause.  Without  harsh- 
ness the  physician  must  draw  the  patient's  attention  to  the 
purely  mental  origin  of  his  insomnia  and  show  him  the  use- 
lessness  of  physical  measures,  and  encourage  him  to  have 
patience. 

Fortunately  in  many  cases  the  preoccupations  are  not  so 
serious.  The  patient  takes  tragically  events  which  are  dis- 
tressing if  one  considers  them  so,  but  which  it  would  be  pos- 
sible to  look  at  with  the  utmost  serenity.  Try  to  teach  your 
patient  a  wholesome  philosophy  which  consists  in  taking  hold 
of  things  by  the  right  end  and  you  will  see  his  calmness  re- 
turn and  his  sleep  come  back. 

But  there  is  one  preoccupation  which  is  especially  danger- 
ous :  it  is  that  of  sleep  itself.  When  one  does  not  sleep  and  is 
impatient  because  he  does  not  sleep,  and  keeps  turning  over 
and  over,  and  growing  worse  and  more  vexed,  one  creates  a 
state  of  agitation  which  hinders  sleep.  Many  patients  ap- 
proach the  night  with  a  fixed  idea  that  they  will  not  sleep, 
and  spend  their  time  reckoning  the  unhappy  consequences 


OF   NERVOUS   DISORDERS          339 

which  this  night  of  insomnia  will  have  for  their  well-being 
on  the  morrow.  They  count  the  bad  nights  which  they  have 
already  had,  persuaded  that  this  one  will  follow  in  line  and 
resemble  the  others. 

To  dissipate  these  phobias  which  prevent  the  mind  from 
attaining  its  necessary  calm,  I  have  been  accustomed  to  tell 
my  patients :  "  Sleep  is  like  a  pigeon.  It  comes  to  you  if  you 
have  the  appearance  of  not  looking  for  it;  it  flies  away  if  you 
try  to  catch  it !  " 

It  is  necessary,  first  of  all,  for  the  patient  to  lose  all  fear  of 
insomnia ;  that  he  should  approach  the  subject  of  the  question 
of  sleep  with  a  perfect  indifference,  which  may  be  summed 
up  in  this  idea :  "  If  I  sleep,  so  much  the  better ;  if  I  do  not 
sleep,  so  much  the  worse !  "  It  is  only  when  the  mental  vi- 
bration ceases  that  sleep  comes  by  itself.  It  is  more  easy  than 
one  would  think  to  lead  the  patients  to  this  philosophy  which 
often  produces  immediate  therapeutic  effect. 

Let  me  give  a  few  examples.  A  friend  who  was  a  physi- 
cian, and  had  just  come  out  of  an  attack  of  melancholia,  told 
me  how  much  improvement  he  had  made,  but  still  showed 
himself  discouraged  on  the  subject  of  insomnia.  He  had  taken 
valerian,  warm  baths,  and  bromide  without  success.  "  Do  not 
be  uneasy,"  I  said  to  him,  "  and  do  not  seek  for  sleep ;  your 
pursuit  only  chases  it  away.  Let  it  come.  There  is  no  danger 
in  a  few  nights  of  insomnia,  even  if  it  were  still  worse  than 
in  your  case.  I  have  taken  care  of  nervous  people  for  more 
than  twenty  years,  and  I  can  assure  you  that  I  have  not  seen 
a  single  case  in  which  the  insomnia  in  itself  constituted  an 
obstacle  to  cure.  One  can  neglect  the  insomnia  without  run- 
ning any  risk  and  that  is  the  best  way  of  bringing  back 
calmness  and  sleep.  Do  nothing  at  all,  take  no  baths  or 
medicine,  and  you  will  soon  recover  your  rest." 

"  You  have  guessed  my  thoughts,"  replied  my  confrere. 
"  I  was,  in  fact,  very  much  concerned  these  last  fevr  nights 
without  sleep.  I  said  to  myself :  '  You  are  better,  you  are 
getting  over  your  melancholy  attack,  but  now  the  insomnia  is 
going  to  tire  out  your  brain  and  melancholia  will  come  back 
again/  My  phobia  has  been  accentuated  by  memory.  One 


340  PSYCHIC   TREATMENT 

day  at  your  sanitarium  I  asked  the  Sister  for  news  of  one  of 
your  patients  whom  I  knew ;  she  replied :  '  Oh !  this  lady  is 
no  better;  she  does  not  sleep,  and  this  insomnia,  wearing  out 
her  nerves,  hinders  her  from  getting  better.' " 

"  Well,"  I  said  to  him,  "  that  phobia  was  unfounded.  The 
patient  of  whom  you  speak  was  suffering  from  an  insanity 
wholly  different  from  that  of  melancholia.  She  has  periods 
of  insomnia,  it  is  true,  but  the  Sister  is  mistaken  in  believing 
that  it  is  the  insomnia  which  encourages  the  trouble.  Believe 
me,  even  persistent  insomnia  has  no  dangers.  Do  not  do  any- 
thing nor  fear  anything;  just  take  it  for  granted  beforehand 
that  everything  will  be  all  right." 

The  very  next  morning  the  patient  told  me  that  he  had  had 
a  good  night.  And  since  then  he  has  had  no  cause  to  com- 
plain of  insomnia.  He  has  recovered  his  health  and  a  capacity 
for  intellectual  work  which  is  above  the  average. 

I  obtained  the  same  result  in  a  few  days  with  a  foreign 
confrere.  At  the  age  of  twenty-three  the  patient  presented 
himself  as  a  neurasthenic.  He  had  neither  anorexia,  dys- 
pepsia, nor  constipation.  His  nervousness  took  the  form  of 
an  almost  persistent  insomnia  which  lasted  for  nine  months. 
He  had  obtained  only  transient  results  by  bromides,  bathing, 
travel,  and  the  cessation  of  all  work.  His  father  was  neur- 
asthenic and  died  of  angina  pectoris;  his  mother  suffered  from 
migraine.  The  patient  had  practised  onanism  and  had  suffered 
from  premature  ejaculation.  He  was  subject  to  stuttering. 

From  the  start  I  drew  the  patient's  attention  to  the  psychic 
causes  of  insomnia  and  counciled  him  boldly  to  stop  all  treat- 
ment, and,  first  of  all,  to  get  rid  of  any  apprehension  of  in- 
somnia. He  succeeded  at  the  end  of  a  few  days  in  getting 
back  his  sleep,  took  up  his  scientific  work,  and  declared  himself 
cured. 

When  preoccupations  hinder  sleep,  one  must  try  to  sup- 
press them,  to  shut  them  up  in  a  drawer.  It  is  difficult,  but 
it  is  not  impossible.  Often  one  succeeds  simply  by  reflect- 
ing on  the  untimely  character  of  such  an  obsession ;  the  ques- 
tion not  being  possible  to  solve  at  that  time  of  night,  is  put 


OF   NERVOUS    DISORDERS          341 

off  until  tomorrow.  But  often,  in  spite  of  these  efforts,  the 
drawer  will  fly  open  and  the  obsession  reappear. 

In  certain  cases  one  may  escape  from  the  obsessions  by 
frankly  taking  hold  of  the  question  which  is  worrying  one  and 
working  it  out  until  it  is  solved.  This  process  often  succeeds 
when  it  is  a  question  of  intellectual  or  scientific  preoccupation. 
It  is  true,  sometimes,  that  association  of  ideas  has  led  to  a 
new  preoccupation  and  everything  has  to  be  done  over  again. 

Sleep  comes  quite  naturally  without  our  seeking  it  when 
our  thoughts,  tho  fixed  chiefly  on  emotional  events,  turn 
around  and  show  us  the  same  persons  and  the  same  places 
in  the  gayest  colors. 

In  caring  for  friends  it  has  often  happened  to  me  that  I 
have  not  slept  for  thinking  of  the  difficulties  of  psychothera- 
peutic  treatment.  I  would  feel  my  patients  slipping  from  my 
hands  and  the  idea  that  the  result  would  be  compromised 
would  haunt  me  and  hinder  me  from  sleeping.  I  would  get 
back  my  sleep  as  soon  as  my  thoughts  would  wander  and  I 
could  see  in  my  patient  the  comrade  of  my  childhood.  A 
pleasant  image  followed  that  which  had  troubled  me  in  my 
mental  kaleidoscope. 

It  is  sometimes  possible  to  provoke  voluntarily  this  change 
of  ideas,  and  to  head  them  in  another  direction.  It  is  like 
imitating  the  coachman  whose  equipage,  traveling  along  a 
road,  comes  upon  danger,  and  who,  quickly  turning  his  reins 
to  the  right  or  left,  throws  his  horses  onto  a  grassy  lawn.  I 
have  counciled  this  measure  for  my  patients,  and  they  have 
succeeded  very  well. 

But  whatever  may  be  the  ruse  to  which  one  has  recourse, 
whether  one  energetically  closes  the  drawer  or  whether  one 
exhausts  the  subject  of  obsessions,  or  whether,  in  short,  one 
tries  to  lead  one's  thoughts  off,  nothing  facilitates  this  mental 
work  like  the  indifference  to  insomnia.  To  wish  to  reach  an 
end  with  all  one's  might  is  to  weary  one's  self  by  not  having 
yet  attained  it;  it  creates  a  new  preoccupation  which  prevents 
sleep.  One  must  also  remember  that  many  of  these  ideas  of 
obsession  are  not  transient  and  borne  only  at  the  time  when 
we  go  to  bed.  They  are  still  followed  through  the  day,  often 


342  PSYCHIC   TREATMENT 

through  several  days  or  weeks.  They  betray  the  depth  of 
our  mental  state.  Then  it  is  not  sufficient  to  struggle  a  few 
moments  or  a  few  hours  at  the  beginning  of  the  night;  we 
must  be  philosophical  by  day  as  well  as  by  night,  and  recognize 
the  insanity  of  these  fears  and  the  uselessness  of  regret,  and 
thus  arrive  at  a  certain  degree  of  stability  in  our  sentiments. 

It  is  the  same  when  sleep  is  disturbed  by  dreams.  My 
patients,  who  have  already  understood  how  efficacious  edu- 
cation itself  may  be,  have  often  objected  that  at  night  they 
can  not  defend  themselves.  "  You  can  not,  however,  demand 
of  me  that  I  should  practise  psychotherapy  while  sleeping," 
they  say  to  me,  "  for  I  really  sleep ;  but  what  fatigues  me 
are  those  distressing  dreams." 

"  Well,"  I  tell  them,  "  I  agree  with  you ;  there  you  are 
disarmed.  But  do  not  forget  that  the  dream  is  only  the 
continuation  in  sleep  of  the  mental  activity  in  the  day.  How- 
ever singular  is  may  appear,  a  dream  is  always  connected 
with  the  previous  mental  state.  It  has  been  noticed  that  in 
a  dream  one  finds  fewer  emotional  events  of  the  day  than 
little  unimportant  incidents;  but  if  one  applies  one's  self,  as 
Freud,  of  Vienna,1  has  done,  to  the  analysis  of  dreams,  and  to 
finding  out  their  original  ideas,  one  perceives  that  they  often 
betray  our  most  secret  aspirations.  It  is  the  same  in  sleep 
provoked  by  anesthetics,  and  many  persons  fear  lest  they  may 
reveal  in  this  condition  of  unconsciousness  the  depths  of  their 
soul.  One  could,  in  connection  with  dreams,  say :  "  Tell  me 
what  you  dream,  and  I  will  tell  you  what  you  are ;  or,  rather, 
as  one  makes  one's  bed,  so  must  one  lie  in  it." 

Thus,  when  my  patients  complain  of  having  slept  badly 
because  they  have  had  disturbing  dreams,  I  do  not  hesitate 
to  say  to  them :  "  What  do  you  want  me  to  do  ?  I  can  not  do 
anything  medical  along  this  line.  We  have  nothing  in  the 
Pharmacopoeia  to  keep  one  from  dreaming.  Try  to  live  dur- 
ing the  day  in  a  perfectly  calm  state;  suppress  by  right 
thoughts  these  useless  annoying  preoccupations,  and  you  will 
sleep  like  a  child."  Sometimes  they  will  reply :  "  But  I  as- 


1  Die  Traumdevtung.    Sigm.  Freud.    Liepzig  und  Wien,  1900. 


OF  NERVOUS   DISORDERS    ,     343 

sure  you  that  when  I  went  to  bed  I  did  not  have  a  single 
troubled  thought."  "  That  is  possible,"  I  would  say  to  them, 
"  but  you  have  been  uneasy  during  the  day.  Do  not  forget 
that  the  waves  do  not  go  down  the  moment  the  wind  which 
worked  them  up  has  fallen." 

It  is  sometimes  good,  when  insomnia  is  greatly  prolonged, 
or  when,  on  coming  out  of  a  nightmare,  one  can  not  get 
hold  of  one's  self,  to  get  up  for  a  moment  and  drink  a  glass 
of  cold  water  and  turn  on  the  light;  but  one  must  avoid  hav- 
ing recourse  to  these  measures  too  often,  for  one  becomes  a 
slave  to  them.  I  have  seen  patients  obliged  to  have  recourse 
to  them  continually.  Some  can  never  go  to  sleep  unless  they 
keep  their  night-light  burning.  Others  can  not  get  along 
without  their  glass  of  water  or  glass  of  milk.  There  are  some 
who  are  obliged  to  prepare  themselves  for  sleep  by  a  sort  of 
autohypnosis,  and  work  from  eight  o'clock  in  the  evening  to 
create  a  condition  favorable  to  sleep.  These  patients  are  not 
cured  of  their  insomnia;  their  preparations  are  subterfuges, 
useful  if  they  are  employed  occasionally,  but  always  trouble- 
some if  they  become  habitual.  Here,  as  in  the  presence  of 
other  symptoms  of  nervousness,  one  must  change  the  men- 
tality. 

I  have  shown  in  a  few  examples  with  what  facility  this 
psychic  conversion  takes  place  in  certain  subjects.  The  officer 
of  artillery  whose  mental  condition  I  pointed  out  as  pessimistic 
succeeded,  after  one  conversation,  in  understanding  the  ne- 
cessity of  looking  on  the  bright  side  of  things,  and  he  imme- 
diately recovered  his  serene  calmness  which  permitted  him 
quiet  sleep. 

A  few  considerations  on  the  psychology  of  sleep  will  be 
sufficient  in  the  two  patients  whose  history  I  will  relate.  The 
interest  of  these  cases  lies  in  the  rapidity  with  which  the 
result  was  obtained  by  means  of  one  or  two  conversations. 
It  is  easy  to  conclude  from  it  that  one  may  nearly  always  reach 
one's  end  when  this  influence  can  be  renewed  every  day  during 
the  treatment  of  insomnia. 

I  would  like,  in  the  sole  interest  of  patients,  to  see  my 


344  PSYCHIC  TREATMENT 

confreres  frankly  adopt  these  psychotherapeutic  methods  for 
the  treatmeent  of  insomnia. 

Shall  my  desire  be  gratified?  I  do  not  know.  The  study 
of  medicine  began  in  superstition  and  by  the  application  of 
simple  and  crude  suggestion ;  blind  faith  played  a  major  role. 
Later  medication  was  studied  more  seriously.  Empiricism 
has  given  some  valuable  specific  aids — a  mass  of  palliative 
drugs,  concerning  the  physiological  action  of  which  we  know 
more  or  less.  We  are,  as  physicians,  perfectly  content  to 
use  these  artificial  means.  We  are  very  well  satisfied  with 
this  intervention  and  the  majority  of  us  can  not  conclude  the 
examination  of  a  patient  without  drawing  out  our  note-book 
to  write  a  prescription. 

Undoubtedly  great  physicians  have  raised  their  voices 
against  the  abuse  of  drug  medication  and  have  pointed  out 
the  value  of  hygienic  and  prophylactic  measures.  But  here 
we  run  against  the  prejudices  of  the  public.  The  patient 
wishes  for  cure  and  immediate  relief;  he  believes  that  the 
physician  who  has  studied  so  much  has  some  remedy  already 
prepared  for  such  disease,  and  that  what  he  will  have  to  do  is  to 
go  to  the  pharmacist  and  get  it.  He  listens  only  distractedly 
to  the  councils  of  hygiene  which  the  serious  physician  gives 
him,  and  he  looks  upon  them  rather  as  measures  intended  to 
favor  the  medicinal  action. 

The  physician  feels  this  influence  of  his  client.  He  be- 
lieves himself  obliged  to  play  the  role  of  healer  conferred 
upon  him  by  his  diploma.  And  then  we  are  lax;  we  have  to 
see  many  patients,  and  it  is  much  more  simple  to  prescribe 
some  medicine  for  them  than  to  give  them  long  explanations 
and  to  regulate  their  lives. 

I  understand  this  mental  state  up  to  a  certain  point,  but 
I  can  not  stop  there.  I  have  not  been  slow  to  see  how  often 
our  therapeutic  attempts  are  illusory,  and  to  establish  the 
purely  suggestive  influence  of  many  medications.  I  have 
felt  later  the  same  reasoning  skepticism  in  the  presence  of 
what  is  to-day  called  "  physical  therapy  " — that  is  to  say,  the 
employment  of  natural  means,  such  as  water,  air,  light,  elec- 
tricity, mechanotherapy,  etc.  I  do  not  deny  the  advantages 


OF  NERVOUS   DISORDERS         345 

which  these  measures  may  present  when  it  is  a  question  of 
dissipating  a  physical  disorder.  But  I  hold  that  it  is  abused, 
and  that  it  often  deludes  us  concerning  the  causes  which  lead 
to  cure  or  improvement. 

Physicians  are  only  too  ready  to  recognize  the  curative 
agent  in  single  influences.  In  mountain  sanitariums  it  is 
altitude  and  purity  of  air  and  insolation.  In  hydrotherapeutic 
establishments  it  is  the  douche  and  the  physical  and  chemical 
properties  of  heat. 

One  forgets  that  a  patient  who  resorts  to  such  treatment 
is  susceptible  to  the  influence  of  various  factors.  He  leaves 
the  environment  in  which  he  lives,  often  escapes  from  weak- 
ening preoccupations  and  overstrain.  He  lives  for  weeks, 
sometimes  for  months,  under  new  conditions — physical  and 
moral  change  of  air;  he  rests,  eats  better,  walks,  bathes,  and 
enjoys  all  sorts  of  distractions ;  and,  lastly,  he  experiences  the 
influence  of  an  amiable  physician,  who,  while  douching  him 
and  prescribing  baths,  knows  how  to  give  his  patient  the  hope 
of  cure. 

In  the  domain  of  the  psychoneuroses  it  is  this  moral  in- 
fluence which  predominates.  I  have  certain  proof  in  the  fact 
that  I  have  been  able,  in  the  course  of  a  rather  long  medical 
career,  to  give  up  all  physical  and  drug  measures. 

Undoubtedly  this  purely  psychotherapeutic  treatment  is 
not  easy.  It  takes  an  immense  amount  of  time  and  patience, 
on  the  part  of  the  patient  especially,  and  as  well  on  the  part 
of  the  physician.  The  practitioner  sometimes  grows  weary  of 
this  work  and  could  be  tempted  to  take  up  the  easier  role 
of  prescribing  drugs. 

But  when  one  has  reflected  on  these  subjects,  when  one 
has  seen  the  patients  recover  their  robust  health  after  years 
of  suffering,  and  regain  their  power  to  work,  and  become 
brave;  when  one  has  seen  them  acting  on  their  environment, 
and  transmitting  their  optimism  to  it  by  the  force  of  conta- 
gion :  then  one  takes  courage,  and  it  is  with  joy  and  unwaver- 
ing patience  that  one  goes  on  with  one's  task,  which  is  always 
to  bring  patients  back  to  a  healthy  life  from  a  triple  point  of 
view — the  psychic,  the  intellectual,  and  the  moral. 


346  PSYCHIC  TREATMENT 

Wavering  enough  in  my  own  mental  state,  and  subject  to 
discouragement,  it  has  often  happened  that  I  have  doubted 
the  efficacy  of  this  psychotherapy.  It  seemed  to  me  impos- 
sible to  continue  it  with  the  same  fervor.  But  these  falls  of 
the  moral  barometer  have  never  lasted  with  me.  Each  day 
I  have  been  able  to  witness  partial  success  which  gave  me 
encouragement,  and  nearly  always  the  final  result  has  forced 
me  to  cry  out :  "  Yes,  you  are  in  the  right  way ;  you  can  con- 
tinue without  wavering,  you  are  doing  useful  work." 

But  to  enter  into  this  path  it  is  not  enough  to  have  merely 
a  mild  faith  in  psychotherapy.  One  must  not  consider  it  as 
a  useful  auxiliary.  One  must  be  persuaded  of  the  mental 
nature  of  the  psychoneuroses.  One  must  not  fear  to  burn 
one's  vessels  in  showing  the  patient  and  his  friends  the  use- 
lessness  of  ordinary  psychotherapy,  and  to  make  the  value  of 
psychic  treatment  shine  in  their  eyes.  This  is  the  price  of 
success. 


OF  NERVOUS   DISORDERS         347 


CHAPTER   XXVII 

Various  Nervous  Attacks  —  Their  Usual  Treatment  by  Antispasmodics. 
Hydrotherapy,  etc. — Advantages  of  Moral  Treatment — Sudden  Ces- 
sation of  Attacks  under  the  Influence  of  Change  of  Environment 
—  In  Hysteria  Everything  is  Mental,  and  the  Treatment  Should  be 
Pjychotherapeutic — Possible  Failures — Persistence  of  the  Hysterical 
Mentality — Moral  Obstacles  to  Cure — Spirit  of  Contradiction — Self- 
esteem — A  Few  Words  on  Traumatic  Hysteria 

THE  phenomena  which  one  recognizes  as  nervous  crises 
are  characteristic  of  hysteria.  They  appear  under  the  most 
varied  forms.  Sometimes  it  is  a  simple  functional  trouble 
or  a  distressing  sensation  arising  suddenly  which  is  described 
under  this  name.  Sometimes  it  is  an  involuntary  movement, 
since  isolated  muscular  shocks  or  palsies,  and  even  convulsive 
attacks,  can  simulate  epilepsy.  In  short,  in  these  states  the 
mentality  is  nearly  always  disordered,  sometimes  so  slightly 
that  the  patients  describe  their  sensations  apparently  without 
any  uneasiness.  Often,  on  the  other  hand,  the  psychic  ele- 
ment is  dominant,  and  one  witnesses  attacks  that  are  almost 
delirious,  which  prove  that  there  is  no  very  great  gap  sepa- 
rating the  psychoneuroses  from  the  insanities. 

For  the  control  of  these  troubles  the  greatest  variety  of 
antispasmodics  have  been  recommended,  among  which  bro- 
mides and  valerian  have  been  held  in  regard  by  physicians. 
These  troubles  have  been  treated  with  certain  success  in 
hydrotherapeutic  institutions  and  in  the  offices  of  electrical 
specialists.  And,  lastly,  have  we  not  in  ovarian  compression 
a  good  way  of  putting  a  check  upon  certain  of  these  con- 
vulsive manifestations  ? 

I  have  not  suddenly  become  skeptical  concerning  the  value 
of  these  various  measures.  From  the  beginning  of  my  life  as 
a  hospital  interne  I  have  been  under  the  impression  that  psychic 


348  PSYCHIC  TREATMENT 

influence  was  alone  the  cause,  and  since  then  I  have  had 
recourse  to  psychotherapy. 

I  had  often  happened  to  have  certain  hysterical  patients 
on  my  service  who  were  prone  to  convulsive  and  delirious 
attacks  which  necessitated  their  immediate  transfer  to  the 
hospital.  They  cried  and  threw  themselves  about  in  a  fright- 
ful manner.  I  witnessed  their  condition  with  patience  and 
gentleness,  I  noted  their  symptoms,  and  then  said  to  them: 
"  Well,  there  is  nothing  very  grave  in  your  condition ;  it  is 
very  unpleasant  for  you,  but  it  will  soon  stop,  you  will  see! 
But,  you  know,  there  are  patients  in  this  room  who  need  rest 
and  can  not  be  present  at  your  attacks.  Repress  these  move- 
ments and  cries,  so  that  we  can  keep  you  here  and  cure  you 
quickly ! " 

Almost  always  I  have  seen  the  attacks  stop,  to  the  great 
astonishment  of  the  relatives,  who  had  tried  in  vain  to  quiet 
the  patient  or  to  intimidate  her  by  threatening  her  with  trans- 
fer to  the  hospital.  She  had  undergone  a  change  of  heart. 
Often  she  had  been  managed  by  main  force,  but  all  this  agi- 
tation ceased  when  she  found  a  kind  presence  in  the  room. 
All  that  was  needed  was  that  the  interne  or  the  Sister  in 
charge  should  have  a  gentle  hand  to  suppress  these  wholly 
exterior  manifestations  of  mental  disturbance. 

The  same  result  is  often  reached  by  an  attitude  diamet- 
rically opposed — by  violent  means  and  intimidation.  I  have 
seen  the  attacks  cease  on  the  application  of  painful  faradic 
currents,  by  treatment  with  an  electric  brush,  by  a  douche, 
by  a  spray  of  cold  water  on  the  head,  or  by  a  blow;  I  have 
seen  patients  intimidated  by  threat  of  a  hot  iron,  of  being  shut 
up  in  a  closet,  or  by  the  authoritative  word  of  the  physician, 
declaring  that  he  would  not  tolerate  such  nonsense.  I  have 
witnessed  such  success  without  pleasure,  persuaded  that  it 
could  have  been  more  surely  obtained  by  gentleness. 

I  never  have  been  able  to  believe  in  the  reality  of  hystero- 
genic  zones  in  the  sense  that  there  would  be  certain  cerebral 
territories  ready  to  let  loose  the  convulsive  attack  under  the 
influence  of  a  peripheral  stimulus.  These  excitomotor  influ- 
ences, or,  on  the  contrary,  inhibitive  influences,  exist  in  epi- 


OF  NERVOUS   DISORDERS         349 

lepsy  where  the  attack  may  sometimes  be  brought  on  by 
pressure  on  a  scar  on  the  scalp,  and  stopped  by  a  band  applied 
to  the  arm  where  the  aura  begins,  or  by  taking  salt  when 
the  attack  begins  by  sensations  in  the  epigastrium. 

In  hysteria,  on  the  contrary,  everything  is  mental:  it  is 
wholly  ideogenic,  and  tho  one  may  very  often  succeed  in  stop- 
ping the  attack  by  pressure  on  a  painful  ovary,  there  is  noth- 
ing physiological  in  this;  it  is  merely  a  suggestive  influence. 
One  could  suppress  it  just  as  well  by  any  other  method,  on 
condition  that  he  could  succeed  in  arousing  in  the  patient 
the  idea  that  it  would  be  efficacious. 

I  have  had  surgeons  send  their  patients  to  me  asking  if, 
to  suppress  the  pain  of  an  articular  neurosis,  one  ought  to 
have  recourse  to  massage  or  an  induced  current.  I  could 
answer  them,  with  good  confidence :  "  It  does  not  matter,  for 
none  of  these  methods  act  materially.  You  will  reach  your 
end  with  or  without  them,  provided  you  can  create  in  your 
patient  the  conviction  that  he  is  going  to  be  cured."  Perhaps 
I  have  not  made  myself  clear. 

Do  not  let  us  ever  forget  that  a  century  ago  Mesmer  suc- 
ceeded not  only  in  calling  forth  by  the  touch  of  metallic  bars 
which  went  out  from  his  magnetic  tub  every  known  hysterical 
manifestation,  but  also  in  making  them  stop.  Let  us  also  never 
lose  from  sight  the  constant  success  of  quacks.  It  must  al- 
ways be  kept  in  mind  that  hysteria  is  a  psychic  trouble.  I 
have  said  the  attack  is  only  a  passional  attitude,  a  demonstra- 
tion by  gestures.  It  ought  to  be  amenable  to  pure  psycho- 
therapy. 

The  numerous  cases  where  hysterical  symptoms  become 
contagious  and  are  communicated  to  other  persons  of  the 
family  and  of  the  house,  prove  the  purely  ideogenic  origin 
of  the  trouble. 

I  am  accustomed  to  see  these  hysterical  manifestations,  es- 
pecially the  dramatic  ones,  stop  during  the  first  days  of  sojourn 
in  a  sanitarium,  often  from  the  first  hours,  under  the  sole 
influence  of  a  change  in  the  moral  atmosphere,  without  even 
giving  myself  the  trouble  to  provoke  the  autosuggestion  of 


350  PSYCHIC  TREATMENT 

the  cure.  Sometimes,  however,  one  must  bring  them  about 
by  conversation. 

Mile.  M was  an  hysterical  patient  with  a  strong  he- 
redity. Her  father  was  alcoholic,  her  brother  suicidal,  and  her 
sister  successively  hysteric,  melancholic,  and  maniacal — first 
confined,  then  cured.  The  patient  had  some  symptoms  of  de- 
pression, such  as  precordial  anguish,  and  religious  scruples 
with  ideas  of  un worthiness  before  God;  she  was  subject  to 
convulsive  attacks,  during  which  she  went  through  the  entire 
gamut. 

One  day  I  was  called  to  see  her.  The  Sisters  in  charge 
did  not  know  what  to  do.  I  found  the  patient  in  convulsions. 
I  quietly  approached  her  bed,  sat  down,  and  felt  her  pulse. 
The  patient  immediately  held  the  wrist  which  I  had  taken 
perfectly  still.  I  noticed  this  peculiarity,  and  I  took  my 
stethoscope,  saying :  "  Pardon,  medemoiselle,  I  wish  to  listen 
to  your  heart."  The  patient  immediately  checked  the  con- 
vulsive movements  of  her  body,  all  the  while  continuing  to 
move  her  arms  and  legs. 

"  Mademoiselle,"  I  said  to  her,  "  you  will  please  be  kind 
enough  to  stop  the  movements  of  your  right  arm  and  of  your 
body,  so  that  I  can  make  the  examination.  Now  do  the  same 
thing  for  your  left  arm,  for  your  head,  and  for  your  legs.  Quiet 
all  this  outer  manifestation  of  your  internal  discomfort.  Be- 
lieve me,  these  gestures  do  not  relieve  you  in  any  way;  on 
the  contrary,  you  exaggerate  the  trouble  by  expressing  it  so 
vividly.  Hold  yourself  as  quiet  as  a  doll  in  the  middle  of 
your  bed  and  it  will  all  pass  away!  I  do  not  by  any  means 
mean  that  you  are  exaggerating  things  and  that  you  are  not 
suffering.  I  know  that  you  are  a  prey  to  a  very  distressing 
disease,  but  I  also  know  that  it  will  cease  as  soon  as  you  are 
mentally  tranquil,  and  it  is  a  great  help  to  this  end  to  sup- 
press all  exterior  manifestations." 

The  attack  ceased  immediately,  and  the  patient  remained 
quiet  for  a  week.  A  new  attack  came  on,  and  the  Sister 
called  me  up  by  telephone.  I  replied,  without  any  hesitation : 
"  Tell  mademoiselle  to  use  the  same  remedy  that  she  did  a 
week  ago !  "  And  I  cut  off  the  communication.  The  next 


OF  NERVOUS   DISORDERS         351 

day  I  went  to  see  my  patient  with  a  certain  timidity.  I  ex- 
pected to  find  her  a  little  bit  annoyed.  She  was  not  so,  how- 
ever, but,  smiling,  she  said  to  me :  "  You  were  quite  right ;  I 
had  forgotten  your  advice,  and  when  the  Sister  returned  to 
me  and  told  me  with  a  malicious  smile,  '  The  doctor  said  to 
use  the  same  remedy/  I  immediately  held  myself  still,  and 
everything  was  all  right."  This  young  person  has  had  no 
more  nervous  attacks  since  then,  and  that  happened  ten  years 
ago. 

Sometimes  one  must  have  recourse  to  a  little  subterfuge, 
and  heighten  the  suggestion  by  a  harmless  medicine,  or  sug- 
gest the  idea  of  cure  by  predicting  immediate  improvement 
before  it  appears.  One  thus  merely  discounts  the  future,  and 
speaks  of  the  present  while  thinking  of  the  future. 

I  was  called  to  an  hysterical  patient  who  had  for  some 
hours  disturbed  the  neighborhood  by  the  sharp  cries  which 
she  uttered.  I  found  the  patient  in  bed,  surrounded  by  a 
crowd  of  people  who  urged  her  to  be  calm.  She  was  seated 
on  her  bed,  with  haggard  eyes,  and  shrieked  as  if  they  were 
going  to  assassinate  her.  I  sent  everybody  away,  allowing 
nobody  but  the  patient's  mother  to  remain.  I  examined  the 
patient,  who  did  not  seem  to  perceive  my  presence,  and,  in 
order  to  give  rise  to  the  idea  that  improvement  would  soon 
take  place,  I  hazarded  the  statement  that  the  pulse  was  al- 
ready less  rapid  and  that  the  respirations  were  growing  slower. 
Then,  turning  to  the  mother,  I  begged  her  to  go  and  lie  down 
in  the  next  room,  for  the  attack  seemed  to  me  almost  over. 
The  cries  of  the  patient  had  already  ceased,  and  she  had  become 
quiet.  Then  I  prescribed  a  little  bromide  for  her,  telling  her 
that  in  a  few  minutes  everything  would  be  all  right,  that  she 
would  go  to  sleep,  and  that  the  next  day  she  could  take  up 
her  work.  On  the  morrow  it  was  evident  that  the  cure  was 
complete  and  decided. 

The  following  examples  show  at  the  same  time  the  influ- 
ence of  contagion  on  the  development  of  the  trouble  and 
the  curative  influence  of  suggestion. 

A  young  servant,  having  broken  a  vase,  was  sent  sudden- 
ly away  by  her  master.  She  returned  to  her  home,  and, 


352  PSYCHIC  TREATMENT 

under  the  influence  of  sudden  emotion,  fell  into  an  hysterical 
delirium,  crying  and  throwing  herself  about.  As  usual,  I 
found  the  room  full  of  neighbors,  whom  I  sent  out  immedi- 
ately. I  tried  to  hypnotize  the  patient,  but  she  was  too  ex- 
cited and  did  not  go  to  sleep.  In  spite  of  this  failure  I  noticed 
that  the  calming  effect  was  produced,  and  the  patient  returned 
in  a  few  moments  to  her  normal  condition.  After  I  had  left 
the  house  I  was  called  to  a  lady  in  the  neighborhood  who  was 
suffering  from  convulsions  and  attacks  of  fainting.  She  had 
seen  the  contortions  of  the  first  patient  and  had  imitated  her. 
I  made  the  same  futile  attempt  at  hypnosis,  the  same  statement 
that  it  would  soon  pass  away,  and  I  let  the  subject  of  my  two 
patients  drop  without  fear. 

The  next  morning  they  told  me  that  the  two  hysterical 
patients  were  doing  well,  that  they  had  slept  and  taken  up 
their  normal  routine,  but  they  begged  me  to  come  to  another 
young  girl  who  was  playing  the  same  comedy.  I  quieted 
her,  and  prescribed  bromide  for  her,  and  at  the  end  of  a  few 
hours  everything  was  all  right. 

Nothing  is  easier  than  to  attain  these  results  in  a  few 
minutes  or  in  a  few  hours  by  simple  moral  influence,  by  giving 
rise,  by  any  means  whatever,  to  the  anticipated  conviction  of 
cure,  and  I  dare  say  that  a  physician  who  allows  these  hys- 
terical conditions  to  continue  for  days  or  weeks  shows  by 
his  therapeutic  helplessness  that  he  does  not  understand  hys- 
teria and  that  he  does  not  take  its  mental  nature  into  account. 
In  the  presence  of  hysteria  the  physician  can  say,  like  the 
prestidigitator :  "  Nothing  in  my  hands,  nothing  in  my  pockets, 
and  yet  I  juggle  away  all  these  people's  troubles." 

Even  with  patients  in  whom  the  mental  condition  seems 
very  much  disturbed,  I  try  to  remain  within  the  bounds  of 
a  wholly  rational  psychotherapy — that  is  to  say,  to  explain  the 
symptoms,  to  make  them  understand  that  they  are  only  nervous 
and  have  no  danger.  I  do  not  hesitate  to  give  a  little  course 
of  nervous  pathology,  to  expose  in  clear  and  concise  terms 
the  influence  of  the  moral  on  the  physical.  But  I  confess  that 
it  is  not  always  possible  to  avoid  crude  suggestion  and  a 
slightly  charlatanesque  form  of  statement.  It  is  sometimes 


OF  NERVOUS   DISORDERS         353 

simpler  to  apply  a  cold  compress  to  the  forehead  and  to  the 
chest,  and  to  prescribe  a  little  bromide  or  valerian  with  a 
purely  suggestive  intent.  It  is  merely  a  question  of  economy 
of  time  for  the  physician. 

But  the  more  I  advance  in  medical  experience  the  more  I 
try  to  make  my  inervention  rational  and  to  avoid  pure  sug- 
gestion. One  must  not  confine  one's  ambition  to  the  sup- 
pression of  the  actual  attack.  One  must  be  concerned  with 
the  correction  of  the  hysterical  mentality,  so  as  to  avoid 
relapses. 

Does  that  mean  that  one  will  always  succeed?  No.  There 
are  some  hysterical  people  who,  in  spite  of  all  the  trouble 
which  a  physician  may  take,  in  spite  of  a  bodily  improvement 
obtained  by  a  prolonged  treatment  under  good  conditions  of 
repose,  rest,  and  overfeeding,  will  show  only  improvement  in 
their  physical  state. 

There  are  some  who,  overflowing  with  apparent  health,  still 
have  hysterical  fever  and  emotional  palpitations,  and  who  are 
taken  at  irregular  intervals  with  attacks  of  delirium  and  di- 
urnal or  nocturnal  somnambulism. 

Therefore,  get  your  patient  to  confess  to  you,  and  you  will 
detect  distressing  preoccupations  and  unhealthy  mental  con- 
ditions created  by  the  circumstances  of  her  life.  Such  a 
young  girl  lives  with  her  parents  in  very  painful  relations; 
she  does  not  get  along  with  her  father  or  her  mother,  and 
family  dramas  will  be  unfolded  which  explain  the  patient's 
mental  state.  Another  has  had  some  love  affair,  has  seen 
all  her  hopes  dashed  down,  and  can  not  wipe  out  these  un- 
happy events.  There  are  some  who  are  ruled  by  sexual 
preoccupations,  who  give  themselves  up  to  onanism,  or  have 
abnormal  relations  with  other  women.  Others  are  prosti- 
tutes, altho  they  do  not  take  any  part  in  the  wicked  world. 
There  are  some  who,  very  young,  have  been  seduced  or  vio- 
lated, and  have  witnessed  dramatic  scenes  of  which  they  still 
retain,  without  confessing  it,  unfortunate  memories. 

It  is  often  difficult  to  discover  these  causes  of  mental  dis- 
equilibrium. Sometimes  the  patients  dissemble,  often  they 
themselves  do  not  know  the  causes  of  their  strange  condition. 


354  PSYCHIC   TREATMENT 

Sometimes,  in  the  suggested  freedom  of  hypnosis,  they  reveal 
their  secret,  but  there  are  others  who  retain  and  preserve  it 
for  years,  until  some  opportune  occasion  arises  to  bring  it  to 
an  end.  There  are  some,  at  least,  who  are  never  cured. 

The  persistence  of  the  attacks  is  sometimes  due  to  per- 
ceptible mental  causes,  and  I  have  seen  the  spirit  of  contra- 
diction hinder  the  cure,  as  it  may  have  been  the  cause  of 
relapses. 

Mile.  H was  an  hysterical  person  thirty  years  of  age, 

who  for  eight  years  had  suffered  almost  continuously  from 
convulsive  attacks  and  delirious  conditions.  She  had  been 
a  morphinomaniac,  and  had  the  skin  of  her  abdomen  covered 
with  scars,  fragments  of  hypodermic  needles  remaining  in 
the  tissues.  Of  a  tuberculous  family,  she  had  a  suspicious 
area  in  the  left  lobe,  and  was  very  emaciated.  With  the  double 
purpose  of  combating  threatened  phthisis  and  hysteria,  I  put 
her  upon  a  complete  treatment  of  isolation,  rest,  and  over- 
feeding. She  responded  to  it  marvelously,  ate  and  grew  fat, 
but  kept  up  her  hysterical  attacks.  She  exasperated  the  Sis- 
ters of  the  sanitarium  where  I  had  placed  her,  and  an  old  nun, 
who  was  somewhat  hasty,  let  herself  go  so  far  as  to  give  her 
a  little  slap. 

With  perfect  right  the  patient  revolted,  and  demanded  her 
transfer  to  another  house,  and  would  no  longer  have  the 
caps  of  the  Sisters  about  her.  I  acceded  to  her  desire  to  be 
alone  in  her  room  and  to  be  waited  upon  by  a  young  servant. 

Noticing  that  the  attacks  persisted,  I  tried  to  work  upon 
her  reason,  and  to  intimate  that  she  could,  in  a  cerain  measure, 
repress  them.  I  set  forth  gently  and  with  all  possible  di- 
plomacy this  inhibitive  influence  of  reason,  but  she  was  "  set." 
She  could  not  accept  this  idea,  and  she  replied  to  me :  "I  am 
sick;  my  movements  are  involuntary,  and  I  can  not  suppress 
them  by  any  voluntary  effort ! "  Finding  her  thus  rebellious, 
I  gave  up  giving  her  any  advice,  and  did  not  pay  any  more 
attention  to  her  attacks. 

However,  one  day  she  went  beyond  all  limit.  In  her 
chemise  she  was  lying  on  the  floor.  She  got  up  as  if  a  prey 
to  madness,  and  made  as  if  she  would  throw  herself  out  of 


OF   NERVOUS    DISORDERS          355 

the  window.  Then  I  said  to  her :  "  Things  can  not  go  on 
in  this  way.  I  shall  be  obliged  to  give  you  to  a  Sister  who 
will  watch  you  day  and  night,"  and  I  pressed  the  button  of 
the  bell  to  call  a  Sister.  The  patient  immediately  came  to 
her  senses,  got  into  bed,  and  remained  quiet. 

"  Well,"  I  said  to  her,  "  you  are  calm ;  that  is  what  I 
would  like  you  to  have  been  in  the  first  week;  you  see  that 
you  have  been  able  to  suppress  your  contortions !  " 

"  No,"  said  she  to  me,  "  I  have  not  done  anything  at  all ; 
my  attack  is  over,  that  is  all." 

"Ah,"  I  objected,  "your  attack  stopped  all  alone,  at  the 
precise  moment  when  I  threatened  to  put  you  under  the  care 
of  a  Sister  whom  you  do  not  like.  Strange  coincidence !  " 
Soon  the  attacks  returned  with  all  their  intensity,  and  the 
patient  left  the  sanitarium  with  a  good  appetite,  a  good  diges- 
tion, regular  movements,  and  with  an  increased  weight  of 
thirty  pounds;  but  a  prey  to  violent  attacks,  as  heretofore. 
But  a  week  later  she  wrote  to  me  from  the  mountains  where 
she  was  making  a  little  sojourn  that  she  had  had  no  more 
attacks.  I  replied,  congratulating  her,  and  saying  to  her: 
"  You  are  one  of  those  persons  who  say  '  No  '  and  mean  '  Yes.' 
That  is  much  better  than  the  inverse  fault."  The  patient  re- 
mained cured. 

It  is  evident  that  here  the  mental  improvement  had  been 
hindered  by  the  spirit  of  contradiction.  The  patient  was 
headstrong,  and  had  stated  from  the  start  that  she  could  not 
by  any  act  of  will  repress  her  hysterical  manifestations. 

To  give  in,  and  to  go  back  on  this  preconceived  and  stated 
opinion  would  have  been  morally  impossible  for  her — at  least, 
so  long  as  she  remained  in  my  presence.  On  leaving  the  sani- 
tarium she  could  yield,  and  she  did  so. 

I  have  seen  this  false  shame  that  patient's  feel  in  yielding 
to  a  psychotherapic  influence  not  only  hinder  the  cure,  but 
provoke  relapses  on  the  return  to  the  family  circle. 

It  is  not,  as  a  rule,  true,  however,  that  the  patients  give 
in  in  the  presence  of  the  physician.  On  the  other  hand,  they 
experience  a  very  natural  repugnance  to  confessing  to  their 
neighbors  and  their  friends  the  rapid  cure  of  their  old  troubles. 


356  PSYCHIC  TREATMENT 

They  fear  that  they  will  say  to  them :  "  What !  you  were  cured 
in  two  months  of  this  trouble  which  lasted  for  years,  and  that 
by  psychotherapic  measures !  But,  then,  you  were  a  '  malade 
imaginaire;'  you  could  have  cured  yourself  long  ago  if  you 
had  had  more  energy.  I  could  have  told  you  that ! "  There 
are  patients  who  fear  such  judgment,  and  who  voluntarily 
prolong  their  convalescence  in  order  not  to  call  forth  these 
unkindly  receptions.  I  have  also  seen  susceptible  ladies  sud- 
denly fall  back  into  their  old  state  on  leaving  a  treatment  which 
had  had  material  success  because  the  treatment  had  been  made 
crudely  and  by  constraint,  and  because  the  physician  had  clum- 
sily recommended  the  husband  to  exercise  too  severe  an  over- 
sight. 

Mme.  X.,  ten  years  ago,  had  taken  the  isolation  treatment 
at  the  sanitarium  of  a  distinguished  physician.  She  had  lost 
the  majority  of  her  symptoms  and  had  gained  nearly  twenty- 
five  pounds.  Unfortunately,  she  had  been  rather  passive  in 
her  response  to  the  treatment.  The  patient  had  been  forced 
to  eat  by  an  attendant  playing  the  role  of  a  Cerberus.  She 
had  given  in,  but  against  her  will.  Nevertheless,  experien- 
cing some  improvement,  she  would  have  been  ready  to  continue 
in  this  right  way;  but  the  physician  was  imprudent  enough 
to  write  to  her  husband:  "Above  all,  do  not  let  your  wife 
slip  back  into  her  old  habits  of  laziness.  Do  not  let  her  take 
up  the  sofa  habit  again !  " 

On  returning  to  her  home  the  poor  woman,  tired  with  a 
long  journey,  stretched  herself  out  on  the  sofa,  and  her  hus- 
band immediately  cried :  "  What !  there  you  are  already  on 
the  sofa.  Are  you  going  to  begin  this  life  of  a  valetudinarian 
again  ?  Has  not  this  long  treatment  been  of  any  use  ?  " 

The  patient,  in  fact,  lost  all  the  good  of  the  treatment,  and 
about  ten  years  later  I  had  to  begin  all  over  again  by  substi- 
tuting the  more  powerful  influence  of  gentleness  and  reason 
for  that  of  harsh  and  inconsiderate  authority. 

The  methods  to  follow  in  patients  with  hysterical  convul- 
sive crises  and  delirious  conditions  vary  according  to  the  case. 
It  depends  upon  the  mentality  of  the  subject  and  the  causes 
which  have  given  rise  to  the  symptoms.  It  is  necessary,  in 


OF  NERVOUS   DISORDERS         357 

order  to  find  the  remedy  to  study  thoroughly  the  psychology 
of  the  patient,  to  get  hold  of  it,  if  I  may  so  put  it,  in  order 
to  restore  it  to  her. 

One  will  yield  to  pure  logic,  and  another  is  carried  away 
by  sentiment.  This  patient  loves  authority,  and  even  demands 
that  her  physician  shall  be  brusque  and  scold  her,  while  another 
loses  all  courage  if  he  raises  his  voice.  Alas!  there  are  some 
who  resist  all  these  means,  and  meet  our  efforts  with  incredible 
inertia.  I  call  them  "  bags  without  handles,"  because  they 
slip  through  our  hands. 

Success  depends,  first  of  all,  upon  the  mentality  of  the 
physician.  He  must  be  master  of  himself  in  order  to  adapt 
himself  to  the  requirements  of  the  moment.  It  has  been  said 
that  one  must  have  an  iron  hand  gloved  in  velvet  for  the 
treatment  of  the  psychoneuroses.  But  this  hand  is  still  rather 
hard,  and  I  prefer  an  ungloved,  supple,  mobile,  and  sensitive 
hand,  such  as  those  of  mind-readers,  who  detect  the  mental 
conditions  of  the  person  to  whom  they  give  their  own  hand. 

Since  we  are  on  the  subject  of  nervous  attacks,  let  us  give 
a  few  lines  to  the  traumatic  neuroses.  I  have  already  said 
that  there  is  no  room  to  create  a  special  morbid  entity  under 
this  title.  Traumatism,  by  the  moral  shock  which  it  produces, 
is  the  provoking  cause  of  a  psychic  trouble,  which,  following 
the  predispositions  of  the  subject,  creates  diverse  conditions 
of  psychoneuroses.  Hysteroneurasthenia  is  the  most  fre- 
quent form,  and  it  is  not  rare  to  observe  in  men  the  convulsive 
forms  that  are  peculiar  to  hysteria.  But  the  prognosis  seems 
to  me  particularly  severe  by  the  very  reason  of  the  psycho- 
logical condition  in  which  the  subjects  find  themselves. 

These  patients,  workmen  for  the  most  part,  have  a  right 
to  demand  indemnity  from  the  industrial  societies  who  employ 
them.  The  very  situation  puts  them  into  a  psychological  state 
of  mind  that  is  very  unfavorable  to  cure. 

I  am  not  speaking  now  only  of  simulators,  or  those  who 
exaggerate  their  troubles  in  order  to  demand  the  sums  of 
money  which  they  have  put  by  for  a  time  of  need.  I  am 
thinking  of  the  conscientious  workmen,  or  persons  of  all 
classes,  who  are  victims,  for  example,  of  a  railway  accident. 


358  PSYCHIC   TREATMENT 

These  patients  know  beforehand  that  the  responsible  com- 
pany will  seek  to  reduce  their  pretensions  and  will  cheapen 
the  sum  of  the  indemnity.  They  therefore  have  a  very  natural 
interest  in  paying  careful  attention  to  all  the  troubles  that 
they  feel,  to  give  them  the  stamp  of  reality.  They  can  hardly 
wish  for  cure  with  the  same  fervor,  for  the  slightest  improve- 
ment may  lead  to  the  reduction  of  the  indemnity. 

If  the  physician  could  guarantee  them  a  certain  definite 
cure,  many  of  these  patients  would  not  hesitate  to  give  up  all 
their  claims,  and  would  prefer  work  rather  than  help;  but  it 
is  on  that  point  that  the  physician,  unfortunately,  can  not  be 
wholly  certain. 

Undoubtedly,  cure  would  be  possible  in  the  majority  of 
these  cases  in  the  psychic  way  alone.  A  case  recently  pub- 
lished by  Grasset  is  typical  in  this  connection.  It  concerns  a 
traumatic  hysteroneurasthenic  cured  in  a  single  day  because 
he  had  dreamed  the  night  before  that  he  was  cured! 

But  as  the  question  here  concerns  the  mentality  of  the 
subject,  it  is  impossible  always  to  give  rise  to  this  conviction 
of  cure  and  to  develop  it.  The  patient,  in  a  lawsuit  with  his 
employers,  is  not  in  a  state  of  mind  that  is  favorable  to  this 
kind  suggestion;  he  is  defiant,  and  the  difficulties  over  which 
he  is  arguing  often  contribute  through  the  course  of  years  to 
aggravate  his  mental  condition. 

Thus  one  sees  the  hysterical  manifestation  hanging  on  for- 
ever, and  resulting  finally  in  a  permanency  which  seems  to 
indicate  organic  changes,  or  the  trouble  proceeds  toward  a 
confirmed  psychosis. 

The  unfavorable  prognosis  of  these  traumatic  psychoneu- 
roses  may  perhaps  also  be  due  to  the  fact  that  they  are  born 
under  the  influence  of  a  violent  emotion  in  people  who  were 
formerly  normal.  The  provoking  agent  acts  with  sufficient 
power,  as  there  may  be  no  reason  to  admit  a  very  marked 
predisposition  or  a  latent  condition  of  hysteria.  The  moral 
"  fracture  "  is  made  abruptly,  and  it  is  with  all  sincerity  that 
the  patient  believes  that  he  recognizes  in  the  accident — that 
is  to  say,  in  an  influence  which  seems  purely  physical — the  sole 
cause  of  his  diseased  condition.  He  is  not  at  all  disposed  to 


OF  NERVOUS   DISORDERS         359 

accept  advice  from  the  moral  standpoint  and  to  aid  the  phy- 
sician in  his  attempts  at  psychic  treatment. 

Yet,  nevertheless,  this  would  be  the  best  means  of  dimin- 
ishing the  number  of  these  traumatic  neuroses  which  are  be- 
coming more  and  more  frequent.  The  laws  for  the  protection 
of  workmen  have  contributed  to  multiply  these  nervous  symp- 
toms. They  tend  to  make  the  injured  person  take  special  note 
of  all  his  ills,  hindering  him  from  treating  them  with  indiffer- 
ence. 

The  physician,  while  preserving  all  his  interest  for  the 
patient  confided  to  his  care,  ought  to  know  how  to  inculcate 
in  him  this  stoicism  in  small  things ;  the  question  of  indemnity 
ought  to  be  promptly  settled  without  a  lawsuit  and  in  a  spirit 
of  broad  equity. 

It  would  then  be  much  more  easy  to  bring  the  moral  influ- 
ence into  play  which  is  the  only  thing  efficacious  in  these 
psychopathic  conditions. 

I  have  often  succeeded  in  this  way  in  dispelling  nervous 
troubles  once  and  for  all,  but  that  was  in  just  such  cases  as 
those  in  which  the  workman,  who  was  considered  by  his  em- 
ployer necessary  to  his  business,  found  himself  face  to  face 
not  with  adversaries  but  with  protectors.  This  situation  is 
exceptional.  In  the  majority  of  cases,  on  the  contrary,  the 
symptoms  grow  worse  and  become  incurable,  or  they  improve 
suddenly  when  the  patient  has  at  last  secured  a  large  indemnity. 

Therefore  these  cures,  which  are  quite  natural  when  one 
takes  the  influence  of  the  moral  on  the  physical  into  account, 
are  very  apt  to  lead  lawyers  and  the  public  and  even  physi- 
cians to  the  erroneous  idea  that  the  patient  is  a  deceiver.  This 
reproach  is  unjust,  and,  wounded  in  his  self-esteem,  the  pa- 
tient makes  up  his  mind,  as  it  were,  to  remain  an  invalid. 


360  PSYCHIC  TREATMENT 


CHAPTER   XXVIII 

Disturbances  of  Motility — Spasms,  lies,  and  Myoclonias — Intervention  of 
Mentality — Professional  Cramps — Influence  of  Uneasiness,  Timidity 
— Charcot,  Brissaud,  Meige  and  Feindel — Psychomotor  Discipline — 
Kinesotherapy  and  Psychotherapy  —  Advantages  of  Pure  Psycho* 
therapy  in  Patients  in  whom  the  Phobic  Element  Predominates 

THE  etiological  role  played  by  ideas  seems  at  first  glance 
less  easy  to  recognize  in  the  various  motor  troubles  which  are 
indicated  under  the  name  of  spasms,  tics,  and  myoclonias,  and 
we  are  far  from  being  in  a  state  of  accord  concerning  the 
place  which  these  affections  ought  to  occupy  in  the  noso- 
logical  list.  I  do  not  include  here  the  convulsive  phenomena 
which  are  due  to  organic  affections  of  the  brain,  spinal  cord, 
or  peripheral  nerves,  nor  the  "  spasms,"  properly  so  called, 
which,  according  to  the  definition  of  Brissaud,  constitute  "  a 
motor  reaction  resulting  from  the  irritation  of  some  point  in 
the  spinal  or  bulbo-spinal  reflex  arc."  I  have  only  in  mind 
those  involuntary  movements  in  which  the  mentality  of  the 
subject  is  involved. 

Before  wondering  if  there  may  be  anything  psychic  in 
the  trouble,  one  must  have  excluded  the  existence  of  any 
organic  affection,  and  one  must  have  proved  the  absence  of 
any  material  irritation  determining  the  convulsive  movement, 
whether  by  the  nervous  or  physiological  path.  One  has  then 
a  right  to  suppose  the  existence  of  a  psychic  influence,  and, 
when  one  analyzes  these  disorders,  which  seem  to  start  from 
the  periphery,  one  easily  discovers  in  the  patients  symptoms 
of  generalized  nervousness.  I  have  observed  a  great  many 
cases  of  cramp  in  writers,  telegraphers,  pianists,  and  in  people 
who  milk  cows.  Undoubtedly  the  frequent  repetition  of  these 
professional  movements  have  been  the  last  cause  of  the  affec- 
tion, but  this  overstrain  is  not  sufficient  to  throw  any  light  on 


OF  NERVOUS   DISORDERS         361 

the  etiology.  First  of  all,  this  overstrain  does  not  exist  always, 
and  one  may  find  the  cramp  occurring  in  people  who  do  not 
write  very  much;  I  have  seen  it  in  employees  whose  business 
was  such  that  they  were  only  obliged  occasionally  to  write 
their  signature. 

For  a  long  time  I  thought  I  recognized  a  peripheral  cause 
in  these  "  functional  cramps."  I  had  often  noticed  in  the 
domain  of  the  affected  muscles,  in  the  thenar  and  first  inter- 
osseous  muscles,  very  distinct  electrical  changes.  At  the  be- 
ginning of  the  affection  there  was  faradic  and  galvanic  hyper- 
excitability  ;  later,  hypoexcitability.  These  are  symptoms  which 
seem  to  indicate  a  modification  of  structure  of  the  nervous 
trunk,  perhaps  an  inflammatory  or  neuritic  process.  They  are 
often  accompanied  by  pains. 

Evidently  all  this  is  material.  These  patients  seem  to  be 
more  vulnerable  from  the  somatic  point  of  view.  They  have  an 
abnormal  fatigability  like  the  neurasthenic.  I  know  some 
subjects  attacked  with  functional  cramps  who  can  not  stand 
up  straight,  and  whose  bodies  are  bent  forward,  without  the 
pains  of  lumbago.  Others  are  taken  with  stiff  neck  at  the 
least  sudden  or  awkward  movement  of  the  muscles  of  the 
neck;  the  painful  cramp  is  immediately  established  if  the  pa- 
tients make  any  unusual  movement  for  even  a  few  moments, 
such  as  that  of  handling  a  screw-driver.  In  virtue  of  this 
special  debility,  their  muscles  are  easily  exhausted. 

But  often  contracture,  weakness,  paresis,  tremors,  or  pains 
(for  these  functional  troubles  are  clothed  in  various  forms) 
appear  even  before  the  movement  begins  or  before  the  fa- 
tigue. It  is  enough,  for  example,  for  the  patient  to  take  a 
pen  in  his  hand  for  the  cramp  to  be  produced  not  only  in  the 
group  of  muscles  brought  into  play,  but  in  muscles  at  some 
distance. 

Two  of  my  patients  attacked  with  this  cramp  of  the  sterno- 
cleido-mastoid  and  of  the  rotators,  which  is  called  "  spasmodic 
wry  neck,"  turned  their  heads  suddenly,  the  one  at  the  moment 
when  I  put  a  pen  into  his  hand  (he  did  not  have  writer's  cramp), 
the  other,  a  physician,  when  he  put  a  spoon  on  the  tongue  of 
a  patient  whose  throat  he  wished  to  examine.  These  move- 


362  PSYCHIC   TREATMENT 

ments  of  the  arm  demand,  it  is  true,  the  use  of  some  uncon- 
scious concomitant  muscles  of  the  trunk  and  of  the  neck, 
which  would  be  sufficient  to  bring  on  the  convulsive  move- 
ment. But  there  is  more.  One  of  my  improved  patients  could 
remain  seated  a  long  time  without  showing  the  slightest  move- 
ment of  rotation  as  long  as  I  talked  with  her  about  indifferent 
things.  Her  head  seemed  as  tho  it  were  moved  by  a  spring 
when  I  put  the  question  to  her :  "  How  is  everything  going 
with  you  now  ?  " 

I  could  try  over  and  over  again  with  the  same  patient  this 
experiment,  which  showed  the  influence  of  mental  represen- 
tation and  attention. 

On  other  patients  I  was  able  to  note  the  influence  of  un- 
easiness and  of  timidity.  A  station-master  who  wrote  with- 
out difficulty  in  his  office  was  immediately  seized  with  cramp 
when  he  was  obliged  to  give  his  signature  to  the  chief  of  the 
train.  He  recognized,  himself,  that  the  fear  of  not  being  able 
to  write  was  the  only  cause  of  his  momentary  helplessness ;  he 
felt  himself  exposed  to  the  jibes  of  the  subordinate  employees 
who  were  around  him.  A  clerk  was  taken  with  writers'  cramp 
only  at  the  end  of  the  day  when  he  had  to  appear  in  the  pres- 
ence of  a  chief  of  whom  he  stood  in  awe,  and  who,  he  thought, 
was  hostile  to  him. 

Thus  we  have  already  seen  causes  that  are  far  from  phys- 
ical. I  by  no  means  deny  the  others;  I  admit,  without  any 
trouble,  in  such  patients  a  fatigability  which  is  wholly  somatic 
as  well  as  a  constitutional  debility.  I  have  often  been  able 
to  recognize  that  this  spastic  disposition  had  been  exaggerated 
by  overstrain,  by  alcoholism,  by  the  use  of  tobacco,  by  in- 
fluences that  were  wholly  material.  However,  I  could  not 
deny  the  evident  role  of  acts  of  conscience,  feelings  of  ti- 
midity and  fear,  which  constantly  intervened  in  the  muscular, 
static,  and  dynamic  muscular  acts.  We  must  not  forget  that 
in  all  fatigue  there  is  an  element  of  ponophobia,  an  antici- 
pated conviction  of  helplessness.  One  is  easily  convinced  of 
this  in  these  patients. 

The  physician  doubles  his  therapeutic  measures  when  he 
knows  how  to  join  to  his  rational  prescriptions  those  of  rest, 


OF  NERVOUS   DISORDERS         363 

suitable  food,  and  advice  on  moral  hygiene,  destined  to  elimi- 
nate the  psychic  causes  of  the  trouble  and  the  mental  condi- 
tions which  give  rise  to  and  encourage  bad  habits. 

The  tics,  by  virtue  of  the  very  easy  way  in  which  they  may 
be  started  up,  are  difficult  of  prognosis ;  particularly  in  the 
complex  form  which  Gilles  de  la  Tourette  has  described  under 
the  name  of  "  maladies  des  tics,"  and  which  is  accompanied  by 
coprolalia,  echolalia,  and  other  insane  manifestations. 

However,  in  many  tics  one  can  detect  the  mental  influence, 
the  transformation  of  the  gesture  of  psychic  origin  into  the 
tic  automatic  in  appearance. 

Charcot  and  Brissaud  have  for  a  long  time  drawn  attention 
to  the  special  mental  condition,  the  eccentricities  and  lack  of 
equilibrium,  of  persons  afflicted  with  tic.  Henri  Meige  *  has 
particularly  insisted  on  this  mental  condition  and  shown  the 
value  of  what  they  derived  from  these  notions  for  thera- 
peutics. 

He  pointed  out  in  these  patients  the  debilitated,  unstable 
will,  the  exaggerated  emotivity,  the  lack  of  equilibrium  and 
of  judgment.  He  did  not  hesitate  to  describe  these  moral 
imperfections  as  psychic  infantilism,  and  detected  in  his  pa- 
tients stigmata  of  degeneration.  He  showed  the  relationship 
of  tics  to  fixed  ideas,  obsessions,  and  phobias. 

And  he  concluded :  "  The  recognition  of  the  mental  con- 
dition of  tiqueurs — people  afflicted  with  tics — is  a  fact  of  the 
first  practical  importance.  The  whole  treatment  of  tic  de- 
pends upon  it.  It  should,  in  short,  have  a  double  object:  the 
correction  of  the  unreasonable  motor  manifestation  and  the 
correction  of  the  psychic  anomalies  of  the  tiqueur.  One  will 
treat  motor  troubles  much  more  efficaciously  if  one  knows  the 
mental  defects  with  which  they  are  intimately  associated." 

The  gradual  transformation  of  the  gesture  in  tic  is  seen 
very  clearly  in  the  various  movements  to  which  the  nervous 
patient  will  give  himself  up  in  the  presence  of  the  physician 
during  the  time  that  attention  is  fixed  on  something  else. 


1  H.  Meige  et  E.  Feindel.    L'i-lat  menial  des  tiqueurs.    Communication  faite  au  Con- 
gres  des  medecins  alienistes  et  neurologistes  de  France.    (L,imoges,  2  aout  1901.) 
H.  Meige  et  E.  Feiudel.    Les  lies  et  leur  traitement.    Paris,  1902. 


364  PSYCHIC  TREATMENT 

Sometimes  these  are  only  manifestations  of  uneasiness  or  ti- 
midity, it  may  be  the  gesture  of  a  young  man  who  is  being 
talked  to  and  who  turns  his  hat  between  his  hands,  who 
scratches  his  ear  or  his  head,  or  pulls  convulsively  at  his 
mustache.  We  all  have  these  little  habits  when  we  are  with 
other  people,  even  tho  we  could  not  distinctly  point  out  the 
psychic  emotion  of  the  uneasiness. 

The  idea  of  occasionally  making  use  of  the  teeth  to  bite 
a  nail  is  natural ;  we  also  try  to  tear  off  a  little  bit  of  skin  which 
is  hanging  from  our  lips.  In  the  mentally  weak  who  can  not 
resist  their  impulses  all  these  movements  become  automatic. 
This  becomes  a  mania.  They  have  designated  under  the 
name  of  onychophagia  and  cheilophagia  these  bad  and  often 
incurable  habits.  In  sick  people  these  disorders  of  motility 
are  much  more  marked ;  they  denote  phobias  and  strange  con- 
victions of  helplessness. 

Mme.  X.  is  a  Jewess  twenty-eight  years  of  age,  somewhat 
degenerate  and  badly  proportioned.  Her  head  is  large,  her 
limbs  short,  and  her  walk  is  waddling,  like  that  of  a  duck.  Im- 
pressionable and  emotional  to  excess,  she  has  agoraphobia  in 
the  highest  degree.  Sometimes  feeling  respiratory  anguish,  she 
gets  the  fixed  idea  that  she  must  draw  her  breath  voluntarily 
in  order  not  to  suffocate.  Thus  she  takes  much  trouble  to 
open  her  mouth  in  a  suitable  way  and  tries  to  raise  the  thorax 
at  regular  intervals.  All  these  movements,  which  are  ordi- 
narily automatic,  are  voluntary  with  her  and  are  clumsily 
performed. 

In  conversations  she  listens  distractedly ;  one  finds  her  con- 
tinually preoccupied  with  herself.  Her  anxiety  is  shown  by  a 
number  of  unconscious  movements.  Sometimes  she  continu- 
ally thrusts  her  first  finger  between  the  leaves  of  a  pocket- 
book  which  she  carries  in  her  hand,  all  the  while  knotting  her 
handkerchief  around  the  latter.  She  puts  one  of  her  feet  in 
a  peculiar  attitude,  forcing  it  around  backward  so  as  almost 
to  bring  the  heel  forward.  She  throws  her  head  back  with  a 
jerking  movement  as  if  to  put  her  hat  in  place,  and  all  the 
time  she  never  forgets  her  respiration  and  forces  herself  to 
draw  her  breath. 


OF  NERVOUS   DISORDERS         365 

I  will  give  you  another  example.  An  abbe  afflicted  with 
serious  neurasthenia  has  for  a  long  time  been  the  prey  of  fears 
concerning  his  heart.  Intellectually  he  has  understood  my  en- 
couragement and  he  is  wholly  persuaded  that  there  is  no  af- 
fection of  the  heart.  But  at  times  he  is  overcome  by  his  fears ; 
they  seize  him  in  spite  of  his  conviction,  and  then  he  is  sud- 
denly plunged  into  rhythmic  movements  with  his  first  finger 
across  the  opening  of  his  shirt,  as  if  he  were  going  to  touch 
his  heart  with  the  point  of  his  finger. 

It  is  no  longer  the  natural  movement  which  makes  a  pa- 
tient put  his  hand  on  his  heart  as  if  to  moderate  the  beating 
or  else  to  feel  it.  It  is  a  sudden  tic  without  any  reason  and 
wholly  involuntary,  but  determined,  as  a  reflex  would  be,  by 
the  anguish  which  seizes  the  patient. 

In  the  presence  of  these  involuntary  movements,  of  these 
intermittent  tics,  occasioned  by  the  most  diverse  emotions,  the 
attitude  of  physicians  is  not  always  what  it  ought  to  be.  It 
seems  to  them  rational  to  exert  a  strong  effort  of  the  will  on 
their  patients.  The  patients  themselves  sometimes  imagine 
that  they  can  repress  their  movements  by  holding  themselves 
in.  But  this  is,  as  a  rule,  wasted  effort.  The  attention  of  a 
patient  is  thereby  fastened  on  the  tic  and  on  the  sensations  and 
ideas  which  have  caused  it,  and  the  impulsion  becomes  still 
more  irresistible. 

In  conversation  with  these  patients  I  pretend  not  fo  notice 
their  movements.  I  do  not  speak  to  them  about  them,  and 
I  try  to  calm  their  primary  emotion,  the  fear  of  the  disease. 
I  give  them  the  conviction  of  the  integrity  of  their  organs, 
raising  their  minds  to  high  conceptions  of  stoicism  and  of 
confidence  in  themselves.  The  patient  thus  becomes  inter- 
ested in  the  subject  and  thinks  intensely;  he  forgets  his  body, 
and  soon,  while  the  consultation  is  still  progressing,  I  see  the 
peculiar  gesture  stop. 

This  impulsive  movement  will  come  back  the  same  day  or 
the  next  day ;  it  may  break  out  very  frequently.  But  one  must 
not  be  discouraged.  Little  by  little,  by  repetition  of  these 
psychotherapic  seances,  the  conviction  of  health  is  established. 
The  fears  have  no  longer  any  serious  foundation,  and,  in  pro- 


366  PSYCHIC   TREATMENT 

portion  as  the  mental  equilibrium  returns,  the  tics  cease  with 
the  emotional  state  which  has  given  rise  to  them. 

There  is  a  chasm  between  this  psychotherapy  which  makes 
the  patient  forget  his  trouble  and  the  other  which  constantly 
holds  it  before  his  eyes,  and  demands  of  one  who  is  not  quite 
balanced  or  aboulic  an  effort  concerning  himself  of  which  we 
ourselves  would  scarcely  be  capable.  The  gesture  is  only  the 
ultimate  reaction;  in  order  to  suppress  it,  one  must  get  rid  of 
the  phenomenon  of  ideation  which  causes  it. 

F.  Brissaud  and  Henri  Meige  *  have  seen  the  value  of  the 
role  of  mentality  in  tics,  and  have  instituted,  under  the  name  of 
"  psychomotor  discipline,"  a  very  rational  psychotherapy.  Con- 
sidering the  tics  as  the  expressing  of  a  false  automatism,  they 
seek  to  develop  the  corrective  power  of  the  cerebral  cortex. 
They  reach  this  result  by  a  methodical  discipline  of  immova- 
bility and  of  movement.  They  replace  an  absurd  and  excessive 
motor  act  by  the  same  movement  executed  logically  and  cor- 
rectly, and  they  very  justly  insist,  in  order  to  give  this  gym- 
nastic movement  the  character  of  a  voluntary  act,  that  the 
subject  shall  have  perfect  confidence  in  himself  and  in  his 
own  mind. 

Their  treatment  is  at  the  same  time  kinesotherapeutic  and 
psychotherapeutic ;  it  applies  to  functional  cramps  or  profes- 
sional cramps,  to  stuttering,  to  motor  manifestations  of  psycho- 
pathic states,  or  stereotypy.  They  extend  to  obsessions,  to 
agoraphobias,  and  they  encourage  those  thus  afflicted  to  go 
a  few  steps  every  day  along  the  way  of  which  they  stand  in 
horror. 

I  do  not  doubt  the  efficacy  of  this  treatment  based  on  a 
just  analysis  of  these  motor  troubles,  in  which  the  psychic 
influence  has  been  until  now  so  little  recognized.  I  will  not 
hesitate  to  make  use  of  it  in  such  cases  which  appear  to  me 
amenable  to  this  method. 

I  should  say,  however,  that  my  psychotherapeutic  views 
are  a  little  different.  This  training  has  its  dangers,  either 
because  it  fixes  his  attention  on  the  functional  disorder  or  be- 

1  P.  Brissaud  ct  Henry  Meige.  La  discipline  psyckomotrice.  Archives  generates 
de  nitklecine,  1903. 


OF  NERVOUS   DISORDERS         367 

cause  it  exposes  the  patient  to  discouragement  in  case  of 
failure. 

In  all  these  cases  where  a  phobia,  a  vain  irrational  fear, 
brings  on  peculiar  movements  or  helplessness  of  the  subject,  I 
prefer  to  dispel  this  primary  mental  condition  by  psychothera- 
peutic  conversation,  instead  of  forcing  the  patient  to  take  gym- 
nastic exercises,  however  graduated  they  may  be. 

I  do  not  send  my  agoraphobiacs  to  battle,  enjoining  them 
to  take  several  steps  in  a  certain  place;  I  do  not  make  my 
patients  with  tic  make  rational  movements,  when  I  detect  in 
them  the  influence  of  a  phobia  or  of  timidity;  on  the  con- 
trary, I  shelter  them  from  failure  by  demanding  nothing  of 
them  or  of  their  wills.  They  must,  little  by  little,  regain  con- 
fidence in  themselves,  forgetting  their  troubles  and  their  past 
failures.  The  automatism  diminishes  or  ceases  then  because 
it  is  not  encouraged  by  repetition.  I  thus  reach  the  result 
by  pure  psychotherapy  without  kinesotherapy. 

This  method,  however  little  it  may  differ  from  that  of 
Brissaud  and  Meige,  is  only  applicable  in  those  cases  in  which 
it  is  possible  to  separate  the  original  idea,  or  the  sentiment 
which  brings  on  the  tic  or  the  helplessness.  The  psychomotor 
discipline  is  used  with  the  best  results  when  the  tic  is  more 
autonomous,  when  it  is  difficult  to  state  exactly  that  it  is 
psychic  in  its  origin,  or  when  the  lack  of  intelligence  in  the 
patient  does  not  permit  one  to  appeal  to  his  reason. 

The  choice  between  these  two  measures  depends  much  upon 
the  mentality  of  the  physician.  One  will  succeed  better  by 
rational  gymnastics,  the  other  will  have  more  confidence  in 
his  convincing  words.  With  a  little  tact  one  can  associate 
the  two  measures,  altho  they  are,  in  a  certain  sense,  opposed, 
the  one  demanding  attention  and  the  other  forgetfulness. 

Extended  myoclonias  following  the  type  of  the  "  paramyo- 
clonus  multiplex  "  of  Friedreich  seem  incurable,  or  in  most 
cases  very  rebellious.  But  one  meets  in  neurasthenic,  hys- 
terical, and  unbalanced  patients  localized  myoclonic  conditions 
which  resemble  tics,  and  which  are  easily  cured  by  psychic 
treatment.  The  following  is  a  good  example: 

M.    H was    a    young    man   of   twenty,    who,    from 


368  PSYCHIC  TREATMENT 

the  age  of  nine  years,  had  been  subject  to  nocturnal  terrors. 
He  describes  himself  as  having  been  always  irritable  and 
easily  angered,  and  he  had  been  excused  from  military  ser- 
vice on  account  of  short-sightedness.  Short  and  thick-set,  he 
had  a  gait  which  slightly  recalled  that  of  the  larger  anthro- 
poids. His  forehead  was  low,  his  face  prognathous,  his  beard 
and  his  hair  were  badly  implanted,  and  his  ears  attracted  at- 
tention. In  spite  of  these  stigmata,  the  young  man  was  in- 
telligent and  gifted.  In  1896,  six  years  before  I  saw  him,  the 
patient  had  been  taken  at  college  with  contortions  of  the  face, 
and  of  his  arm  and  leg  on  the  left  side.  These  peculiar  move- 
ments only  lasted  for  a  few  moments,  and  did  not  reappear 
under  the  same  form  until  three  months  after. 

Soon  the  attacks  became  more  frequent,  and  were  repeated 
several  times  a  day  at  regular  intervals,  chiefly  during  his 
hours  of  study,  so  much  so  that  the  patient  had  to  interrupt 
his  work  and  spend  several  months  with  a  physician  who 
stuffed  him  with  bromide  (as  much  as  fifteen  grams  a  day). 
His  condition  improved  little  by  little,  but  upon  taking  up  his 
work  he  was  seized  with  a  prompt  relapse. 

Hydrotherapeutic  treatment  was  tried  in  1898  without 
effect.  Various  medications  were  successively  tried,  such  as 
lactophenine  and  antipyrine,  but  without  success.  Neverthe- 
less, the  attacks  suddenly  grew  less  and  seemed  to  stop  in  1899. 
A  boil  caused  them  to  reappear  again  more  violently  than  ever. 
The  patient  was  then  placed  in  the  sanitarium  of  a  neur- 
ologist who  put  him  upon  Weir  Mitchell's  treatment,  during 
which  his  bodily  weight  increased  twenty-three  pounds.  The 
rest  and  isolation  were  kept  up  for  seven  months.  The  pa- 
tient went  away  improved  but  not  cured. 

At  the  time  when  I  saw  the  patient  the  attacks  were  no 
longer  complete ;  the  trouble  was  more  localized  and  the  action 
consisted  in  a  movement  of  pronation  of  the  forearm  with  ex- 
tension of  the  hand  and  thumb,  accompanied  by  a  synchronous 
movement  of  the  foot  from  behind.  There  was  a  certain  an- 
alogy between  this  chronic  cramp  and  the  movement  which  a 
ball-player  makes  when  he  curves  his  ball,  and  when  he  wants 
to  direct  it  by  a  suggestive  gesture.  These  contractions  lasted 


OF  NERVOUS   DISORDERS         369 

about  fifteen  seconds  and  recurred  three  or  four  times  a  day; 
in  the  worst  periods  he  had  about  fifteen  attacks  in  the  twenty- 
four  hours. 

My  patient  had  already  gone  through  treatments  of  rest, 
isolation,  and  overfeeding.  I  no  longer  had  the  resources  of 
these  material  means,  and  I  saw  at  a  glance  that  nothing  was 
left  for  me  but  moral  influence.  I  did  not  fear  to  confess 
frankly  to  the  patient  that  I  would  proceed  in  the  following 
manner : 

First,  I  justified  in  his  eyes  the  rest  treatment  which  he  had 
undergone  and  which  he  criticized  rather  unkindly.  I  showed 
him  that  if  it  had  perhaps  been  prolonged  a  little  more  it  might 
have  had  the  advantage  of  strengthening  him,  and  that  it  would 
have  brought  about  a  notable  improvement.  I  declared  to 
him  that  I  would  have  had  recourse  to  the  same  treatment  if 
I  had  had  the  care  of  the  disease  from  the  start. 

I  then  set  before  my  patient  my  views  on  the  intervention 
of  the  idea  in  spasmodic  affections.  I  explained  to  him  the 
effests  of  fear  and  expectant  attention.  I  insisted  on  making 
him  understand  that  the  very  repetition  of  the  attacks  rendered 
the  "  going  off  "  more  and  more  easy,  and  the  "  trigger  "  too 
free,  and  that  it  would  be  greatly  to  his  interest  to  diminish 
the  number  of  his  daily  attacks.  But  I  added  that  this  result 
was  only  possible  by  the  psychic  method,  since  physical  treat- 
ment had  not  been  able  to  cure  him.  And,  without  any  hesi- 
tation, I  advised  toward  this  end  a  stoical  attitude  and  an  in- 
difference to  the  symptom. 

"  If  your  cramp,"  I  said  to  him,  "  was  accompanied  by 
very  painful  phenomena,  I  would  perhaps  not  dare  to  advise 
you  to  deny  your  suffering.  But  you  yourself  say  that  it  is 
not  painful;  it  is  an  involuntary  gesture  which  lasts  a  few 
seconds.  Is  it  asking  too  much  of  you,  then,  to  say :  think  no 
more  about  it,  act  as  if  it  did  not  exist  ?  " 

Without  any  other  treatment,  under  the  conditions  of  a 
simple  sojourn  in  the  country,  without  rest,  and  without  iso- 
lation, the  crises  diminished  rapidly  in  frequency,  and  at  the 
end  of  a  fortnight  the  patient  was  cured. 

A  wholly  moral  influence  brought  on  a  relapse.    The  pa- 


370  PSYCHIC  TREATMENT 

tient,  having  still  eight  days  left  before  he  was  to  begin  his 
studies  again,  was  advised  to  sojourn  in  the  country  at  the 
home  of  a  physician.  I  hoped  thus  to  preserve  his  cure,  and 
to  lead  the  young  man  little  by  little  to  regular  activity.  But 
I  counted  without  his  father,  an  authoritative,  self-made  man, 
who  thought  it  wise  to  keep  his  son  at  home. 

The  young  man  was  very  much  opposed  to  it.  Confident 
in  the  wisdom  of  this  supplementary  treatment,  he  took  it  into 
his  head  that  neglect  of  my  prescription  was  going  to  compro- 
mise the  result  that  had  been  obtained;  and,  in  fact,  the  at- 
tacks reappeared,  so  much  so  that  at  the  end  of  two  months 
they  brought  him  back  to  me. 

I  succeeded  in  convincing  the  father  by  showing  him  that 
his  conduct  toward  his  son  was  the  only  cause  of  his  relapse, 
and,  putting  the  patient  once  more  on  psychic  treatment,  I 
had  no  trouble  in  leading  him  to  forget  his  troubles.  He  un- 
derstood still  better  the  action  of  the  moral  on  the  physical 
when  I  analyzed  with  him  the  causes  of  his  fall. 

I  took  care  to  make  him  notice  that  it  was  not  spite,  or 
an  emotional  feeling  of  that  type,  which  had  brought  on  the 
symptoms  in  a  nervous  way,  but  it  was  the  idea  that  had  done 
it :  "  My  father  does  not  want  to  do  what  the  physician  has 
advised;  very  well,  then,  he  will  see,  I  am  going  to  have  my 
attacks  again !  "  And,  always  concerned  for  his  future  moral 
attitude,  I  added :  "  I  believe  that  I  have  brought  your  father 
around  by  my  conversation  to  more  correct  ideas ;  I  will  write 
to  him  again  and  I  have  every  reason  to  hope  that  he  will 
permit  you  to  make  this  visit  to  a  physician.  But  do  not  think 
that  your  cure  depends  upon  events  which  are  independent  of 
your  own  will.  Do  not  be  at  the  mercy  of  the  decisions  of 
others.  Take  the  firm  resolution  to  be  cured,  and  say :  'If 
my  father  agrees,  so  much  the  better ;  if  he  will  not  understand, 
so  much  the  worse;  that  will  not  hinder  me  from  getting 
well.' " 

The  young  man  understood  these  councils  from  the  first, 
and  the  improvement  was  not  long  in  coming.  The  few  attacks 
which  he  still  had  in  the  fortnight  of  treatment  furnished  both 
of  us  the  opportunity  to  prove  the  moral  influence. 


OF  NERVOUS   DISORDERS         371 

One  day  I  found  him  in  my  study,  and  I  noticed  that  he 
got  up  very  slowly.  I  asked :  "  What  is  the  matter  with  you  ? 
Have  you  lumbago,  that  makes  you  move  so  slowly?  " 

"  No,"  replied  he,  "  but  I  notice  that  when  I  get  up  quickly 
my  cramps  return  more  easily." 

"  What  is  this,  my  friend  ?  I  have  told  you  to  neglect  your 
troubles  and  act  as  if  they  did  not  exist,  and  here  you  are 
taking  precautions  to  avoid  them!  Do  you  not  know  that 
that  is  the  best  way  to  bring  on  the  attack?  " 

The  patient  understood,  and  the  next  day  showed  me  a 
new  proof  of  the  intervention  of  the  idea  by  saying  to  me: 
"  I  had  an  attack  yesterday,  but  I  saw  where  it  came  from  and 
that  will  not  happen  to  me  again.  While  seating  myself  at  the 
table  I  offered  my  chair  to  a  lady,  and,  going  to  get  another, 
I  felt  a  little  uneasiness.  I  said  to  myself :  '  Everybody  is  look- 
ing at  you,  your  cramp  is  going  to  come ! '  And,  in  fact,  it 
did  come,  but  be  assured  I  will  not  let  myself  be  seized  with 
that  apprehension  any  more."  The  patient  then  made  his 
visit  in  the  country,  as  I  had  proposed,  without  a  relapse.  I 
saw  him  a  year  later  and  his  cure  had  continued. 

In  all  these  spasmodic  conditions,  with  clonic  or  tonic  con- 
tractions, which  do  not  arise  from  cerebral,  medullary,  or 
peripheral  affections ;  in  all  the  palsies  which  are  not  sympto- 
matic of  the  early  stages  of  senility,  of  multiple  disseminated 
sclerosis,  of  paralysis  agitans,  or  of  habitual  intoxication,  one 
must  think  of  the  spychic  influence,  of  the  feelings  of  timidity, 
and  even  of  defiance,  which  lead  to  muscular  action ;  one  must 
not  forget  the  expectant  attention  which  favors  a  transition 
of  the  idea  into  an  action,  altho  unknown  even  to  the  person 
acting. 

In  the  permanent  contractures  which  one  observes  chiefly  in 
hysteria  it  is  more  difficult  to  trace  the  psychic  origin.  In  cer- 
tain cases  where  the  contracture  follows  a  traumatism  or  a 
muscular  effort  one  may  suppose  that  it  is  established  by  auto- 
suggestion, like  the  psychic  paralysis  which  follows  the  con- 
tusion of  a  limb.  The  facility  with  which  one  can  bring  on 
conditions  of  contracture  and  of  catalepsy  by  suggestion  in 


372  PSYCHIC   TREATMENT 

hypnosis  or  in  the  waking  condition  gives  some  idea  of  this 
mechanism. 

But  the  psychic  nature  of  these  phenomena  is  shown  much 
more  distinctly  by  the  sudden  cure  following  a  purely  moral 
influence. 

One  of  my  patients,  attacked  with  contracture  of  the  left 
leg,  dating  back  several  months  and  accompanied  with  hys- 
terical fever,  was  cured  suddenly  in  a  single  day,  because, 
alone  and  wandering  until  that  time,  she  found  a  refuge  in 
the  home  of  a  brother ;  her  joy  cured  her. 

Another  whose  neck  and  jaw  had  been  immobilized  for 
years,  and  who  had  undergone  unsuccessfully  medical  and 
surgical  treatment  from  the  most  renowned  clinicians,  found 
sudden  cure  in  the  piscina  of  Lourdes. 

By  crude  suggestion,  as  well  as  by  gentle  persuasion,  by 
threats  as  well  as  by  kindness,  one  can  cause  these  motor 
disorders  to  cease,  even  when  one  can  not  detect  the  pathogenic 
idea.  In  all  these  conditions,  in  which  one  recognizes  the  in- 
fluence of  mental  representations,  one  must  have  recourse  to 
one's  finest  and  most  acute  perceptions  in  order  to  work  upon 
the  whole  gamut  of  the  feelings,  and  thus  attain  by  psycho- 
therapy the  desired  end. 

The  majority  of  physicians  put  this  moral  influence  in  a 
secondary  place,  hoping  for  more  from  physical  measures, 
active  or  passive  gymnastics,  massage,  and  local  electrical 
applications.  Even  if  they  are  skeptical  over  the  real  effi- 
cacy of  these  means  they  consider  them  good  to  suggest  cure. 
Without  doubt  these  procedures  can  bring  success,  but  they 
are  often  dangerous;  they  are  double-edged  weapons.  This 
local  therapy  encourages  in  the  patients  the  idea  of  a  local 
trouble  and  fixes  the  attention  on  the  organ  which  is  disturbed 
in  its  functioning. 

I  have  seen  many  patients  who  have  owed  the  chronic 
nature  of  their  trouble  to  such  therapeutic  measures.  It  would 
be  better,  according  to  my  idea,  to  forget  the  local  symptoms, 
and  to  give  it  less  importance  in  the  patient's  mind — to  "dilute" 
his  trouble,  as  one  might  say,  by  describing  it  as  more  ex- 
tended and  more  psychic.  This  is  easy  when  one  studies  the 


OF  NERVOUS   DISORDERS         373 

mentality  of  the  patient,  and  when  one  makes  him  put  his 
finger  on  his  psychic  defect. 

One  thus  gives  birth  to  that  appetite  for  cure  which  cor- 
rects the  psychic  mentality,  and  without  knowing  how  the  old 
rebellious  local  trouble  is  scared  away  in  this  psychic  move- 
ment of  regeneration.  I  insist  on  purpose  on  this  fundamental 
idea  that  in  all  these  patients  where  psychic  influence  pre- 
dominates, one  must  turn  the  patient's  attention  away  from 
the  troubk  which  disturbs  him  and  make  him  forget  it. 

From  the  etiological  and  therapeutic  point  of  view,  one 
can  compare  these  spastic  phenomena  with  vasomotor  troubles. 
Under  the  name  of  obsession  of  blushing,  erethrophobia,  phy- 
sicians have  described  these  agonizing  conditions  in  which 
the  patient's  blush  comes  at  everything  where  the  fear  of 
blushing  is  enough  to  make  one  blush. 

It  is  easy  to  detect  signs  of  nervousness  in  these  patients. 
They  are  neurasthenic  and  unbalanced.  It  is  evident  here 
also  that  the  cause  is  wholly  psychic,  and  that  we  have  no 
other  recourse  than  that  of  psychotherapy.  We  can  not  pre- 
vent these  emotional  movements  with  douches  and  bromides. 
It  is  not  possible  here  to  practise  kinesotherapy.  One  must 
discover  the  uneasiness,  or  the  timidity,  or  the  various  preoc- 
cupations which  drive  the  blood  to  the  face.  One  must  give 
the  patient  confidence  in  himself.  The  same  is  true  in  all 
physiological  reactions  which  follow  emotion,  tears,  cardiac 
palpitation,  dyspnea,  and  intestinal  troubles.  One  must  get 
back  to  the  origin  of  the  trouble  and  dispel  the  primary 
mental  condition  which  has  brought  on  the  functional  dis- 
turbance. 


374  PSYCHIC  TREATMENT 


CHAPTER   XXIX 

Conditions  of  Helplessness  in  Various  Motor  Domains — Their  Psychic 
Origin  —  Paraplegia  —  Hysterical  Astasia-abasia  —  Stasophobic  and 
Basophobic  Symptoms  in  the  Course  of  Other  Psychoneuroses — 
Example  of  Cure  by  Pure  Psychotherapy 

CONDITIONS  of  paralysis  and  of  astasia-abasia  form  part 
of  the  symptomatology  of  hysteria.  Everybody  knows  these 
paralyses  as  localized  in  a  functional  muscular  group,  and 
appearing  in  the  wake  of  a  known  or  unknown  autosugges- 
tion, may  disappear  as  if  they  were  caused  by  suggestive 
influence.  The  fact  is  a  commonplace  one  in  the  domain  of 
hysteria. 

What  is  not  so  well  known  is  that  a  simple  dream  can 
cause  these  states  of  motor  helplessness.  I  have  seen  paralysis 
of  the  right  arm  occur  in  a  little  girl  who  dreamed  she  had 
defended  her  dog  when  attacked  by  a  cow,  and  had  struck 
blow  after  blow  at  the  aggressor. 

Moreover,  one  must  remember  such  demonstrative  cases 
as  that  of  Grasset,  where  the  dream  brought  about  the  cure. 
A  single  example  of  this  kind  is  enough  to  show  us  the  nature 
of  these  paralyses  and  to  direct  our  conduct. 

There  are  some  complex  cases  where  the  diagnosis  must 
be  made  by  exclusion,  by  eliminating,  little  by  little,  by  a 
conscientious  examination,  cerebral,  medullary,  radicular,  and 
peripheral  paralyses. 

As  a  rule,  the  form  of  paralysis,  its  distribution,  the  dis- 
turbances of  sensation  which  accompany  it,  or  the  mental 
condition  of  the  subject,  are  sufficient  to  settle  the  diagnosis. 

There  is  generally  no  room  for  doubt  when  it  is  a  question 
of  hysterical  paraplegia  occuring  suddenly  under  the  influence 
of  anger  or  of  spite.  The  paralysis  is  most  often  accompa- 
nied by  contracture  of  the  extensors  and  anesthesia.  It  is 


OF  NERVOUS   DISORDERS         375 

the  result  of  a  psychic  shock,  and  is  only  an  exaggeration  of 
the  feeling  of  motor  helplessness  which  takes  possession  of 
us  under  emotion  and  which  we  express  by  saying  that  "  our 
legs  give  way  under  us !  "  Transient  in  the  normal  man,  the 
phenomenon  becomes  lasting  in  the  hysterical  patient  who  is 
always  disposed  to  believe  that  the  slightest  functional  dis- 
turbance is  real.  The  influence  which  the  conviction  of  cure 
alone  may  exercise  is  easy  to  show  in  these  cases  which  are  so 
frequent  in  daily  practise. 

Mme.  W ,  after  an  altercation  with  her  cook,  was 

seized  with  paraplegia.  I  found  the  patient  in  bed,  very  much 
disturbed  by  what  had  happened.  Her  legs  were  in  tetany 
when  stretched  out,  and  the  patient  was  incapable  of  making 
the  slightest  movement.  Sensibility  to  a  prick  ceased  over  the 
whole  cutaneous  surface  of  the  lower  extremities,  and  the  anes- 
thesia ceased  suddenly  at  the  fold  of  the  groin. 

While  I  made  the  examination  the  patient  asked  me :  "  Is 
it  serious  ?  Shall  I  have  to  stay  a  long  time  in  bed  ?  " 

"  Serious !  Not  in  the  least ;  it  is  only  a  nervous  weakness 
brought  on  by  emotion.  In  three  days  you  will  be  on  your 
feet!" 

Then,  taking  her  relatives  to  one  side,  I  took  care  to  say 
to  them :  "  You  have  heard  that  I  have  said  she  will  be  cured 
in  three  days;  I  could  have  said  three  weeks,  three  months, 
or  more,  for  I  have  seen  these  paraplegias  last  for  years.  It 
all  depends  upon  the  idea  that  the  patient  gets  into  her  head. 
Take  care,  then,  to  take  it  for  granted  that  the  patient  will 
be  cured  within  the  fixed  time.  Do  not  make  believe  to  be- 
lieve it ;  that  will  not  do ;  believe  it — all  of  you  believe  it !  " 

Without  any  other  treatment  the  patient  was  cured,  and 
walked  on  the  third  day. 

A  friend  has  quoted  to  me  an  analogous  case  in  which  the 
telephone  brought  about  the  cure.  A  lady  under  the  influence 
of  anger  fell,  paralyzed  in  both  her  limbs.  A  physician  was 
called  in;  he  put  on  a  serious  air,  said  that  the  legs  were 
paralyzed,  that  it  would  last  a  long  time,  and  advised  her 
transfer  to  a  hospital.  While  her  husband  had  gone  to  make 
the  necessary  formal  arrangements,  and  the  servant  had  gone 


376  PSYCHIC  TREATMENT 

out  to  make  purchases,  the  patient  remained  alone  in  bed. 
Suddenly  the  bell  of  the  telephone  sounded.  She  started  up 
and  tried  to  call  the  neighbors,  but  nobody  replied.  There 
was  another  ring,  the  sharpness  of  which  denoted  the  impa- 
tience of  the  person  who  was  waiting.  The  patient  was  over- 
come with  agitation.  Then  a  third  ring  came,  imperious  and 
prolonged.  The  patient  got  up,  went  to  the  telephone,  and 
she  was  cured ! 

Notice  the  imprudent  remarks  of  the  physician.  He  pro- 
nounced the  word  "paralysis,"  which  is  not  even  correct, 
medically  speaking,  when  the  helplessness  is  wholly  psychic, 
and  which  is  always  interpreted  by  the  public  in  an  unfavor- 
able sense.  He  announced  that  "  it  would  last  a  long  time  " 
without  taking  into  account  the  fact  that  he  was  thus  estab- 
lishing a  suggestion  which  would  encourage  the  functional 
helplessness. 

Let  me  give  another  example.  Mme.  S was  a  nervous 

person  who  had  already  had  symptoms  of  hysterical  paresis 
and  of  emotional  tachycardia,  as  well  as  fits  of  depression. 
She  lived  in  a  dependent  position,  exposed  to  annoyances  and 
wounds  to  her  self-esteem.  She  had  no  appetite,  and  slept 
badly;  she  had  headaches,  and  little  by  little  she  lost  the  use 
of  her  lower  limbs. 

The  patient  admitted  this  weakness  with  anxiety,  and 
cried :  "  I  am  paralyzed,  am  I  not  ?  "  For  a  moment  I  re- 
flected :  "If  you  say  yes,  the  patient  will  despair  and  will  be 
paralyzed ;  if  this  condition  lasts  a  long  time  her  position  will 
be  very  pitiful,  for  the  patient  can  not  be  cared  for  in  the 
unsympathetic  environment  in  which  she  lives.  She  can  not 
enter  a  special  sanitarium  because  she  is  without  the  means 
of  existence,  and  she  is  too  proud  to  go  to  a  hospital."  So 
without  hesitating,  I  replied :  "  Paralyzed !  What  are  you 
saying  ?  You  only  have  a  little  nervous  fatigue  which  is  easily 
explained  after  the  annoyances  to  which  you  have  been  ex- 
posed. Don't  be  in  the  least  uneasy;  you  will  be  better  to- 
morrow." 

The  cure  followed  in  several  days.  "A  medical  lie,"  you 
will  say.  No,  frankly  not,  for  a  psychic  impotence  is  not  an 


OF   NERVOUS   DISORDERS          377 

organic  paralysis.  There  has  been  a  careful  distinction  made 
between  paraplegia  and  the  condition  of  hysterical  astasia- 
abasia,  and  with  good  reason,  from  the  symptomatological 
point  of  view,  for  these  astasic  patients  have  neither  con- 
tracture  nor  anesthesia,  and,  tho  incapable  of  standing  up, 
can  use  their  limbs  when  lying  down.  A  still  stranger  phe- 
nomenon is  that  these  patients  who  can  not  stand  up  can 
sometimes  walk,  run,  jump,  and  dance  as  long  as  they  are 
not  interfered  with. 

But  from  the  etiological  and  therapeutic  point  of  view, 
the  distinction  becomes  useless.  As  in  paraplegia,  it  is  a 
question  of  the  conviction  of  helplessness;  this  can  often  be 
suppressed  by  a  word. 

Mile.  B is  a  young  girl  seventeen  years  of  age.  In 

1891  she  underwent  a  plastic  operation  of  the  anus,  which 
obliged  her  to  stay  in  bed  for  three  weeks.  She  was  nervous, 
had  no  appetite,  and  complained  of  pains  in  the  back  and  in 
the  ovarian  region.  When  the  cicatrisation  was  complete  the 
patient  was  permitted  to  get  up,  but  she  found  that  she  could 
not  stand;  nevertheless,  in  bed  she  had  no  trace  of  paralysis. 

The  physicians  who  were  called  recognized  the  beginning 
of  an  hysterical  astasia-abasia,  but,  forgetting  the  mental 
mechanism  by  which  her  helplessness  was  established,  they 
had  recourse  to  hydrotherapy,  faradisation,  and  the  applica- 
tion of  magnets.  But  it  was  in  vain;  the  helplessness  per- 
sisted, the  rachialgia  was  accentuated  and  extended  as  far  as 
the  nape  of  the  neck,  and  the  classic  anesthesia  was  present 
in  the  right  leg. 

Professor  Dejerine  saw  the  patient  five  months  after  the 
beginning  of  these  symptoms.  He  considered  psychotherapic 
treatment  indispensable,  took  the  affirmative  stand,  predicted 
cure,  and  sent  the  patient  to  me. 

I  settled  the  young  girl  in  a  sanitarium,  with  the  intention 
of  making  her  undergo  a  treatment  of  complete  isolation,  rest, 
and  overfeeding,  and  I  expected  to  see  the  symptoms  diminish 
little  by  little  under  the  influence  of  these  psychic  measures. 
I  had  not  at  that  time  been  able  to  see  clearly  enough  that 
cure  depends  only  on  the  mental  condition. 


378  PSYCHIC   TREATMENT 

Therefore,  on  the  sixth  day,  when  the  scanty  milk  diet 
had  not  yet  sufficiently  renewed  her  strength,  and  when  noth- 
ing physical  had  acted  upon  the  patient,  she  announced  to  me 
that  she  could  stand  up.  A  few  days  afterward  she  was 
walking.  I  kept  her  a  few  weeks  longer  to  overcome  the 
other  nervous  troubles,  but  the  symptom  of  astasia-abasia  had 
disappeared  under  the  powerful  suggestion  which  Professor 
Dejerine  had  exercised  by  his  sincere  and  comforting  words. 

In  a  boy  ten  years  of  age  whom  I  saw  soon  after  the 
cure  followed  more  slowly.  The  patient  had  a  very  bad  hered- 
ity. The  father  was  insane,  and  confined  in  an  asylum ;  the 
mother,  who  had  been  a  shrew  and  bad  tempered,  had  died  of 
a  cerebral  affection.  The  paternal  grandfather,  melancholic 
and  confined  for  ten  years,  had  made  attempts  at  suicide.  An 
uncle  was  equally  melancholic,  and  there  was  a  brother  suffer- 
ing from  heart  trouble  and  melancholia. 

The  young  patient  was  taken,  in  1891,  with  general  fatigue, 
and  attacks  of  vertigo,  anorexia,  and  pains  in  the  vertebral 
column,  which  obliged  him  to  lie  on  his  side.  Signs  of  pul- 
monary congestion  were  found  and  influenza  was  suspected. 
At  the  end  of  three  months  the  patient  seemed  convalescent, 
but  he  could  not  stand  up ;  he  said  he  was  dizzy. 

This  state  grew  worse;  vomiting  occurred,  and,  later,  par- 
alysis of  the  right  leg.  Hysteria  was  thought  of,  and,  as  usual, 
massage  was  given,  with  mild  suggestions.  The  vomiting  and 
vertigo  persisted,  and  in  a  consultation  the  hypothesis  of  a 
cerebellar  neoplasm,  probably  of  a  tuberculous  nature,  was 
put  forth. 

When  I  saw  the  patient,  seven  months  after  the  beginning 
of  the  disease,  the  symptomatology  was  simplified,  and  it  was 
easy  to  recognize  the  clinical  picture  of  astasia.  The  Mitchell 
treatment  was  begun,  but  as  I  only  saw  the  patient  from  time 
to  time  in  the  sanitarium  of  a  confrere  I  could  not  exercise 
upon  him  all  my  suggestive  authority.  However,  the  cure 
followed  at  the  end  of  five  weeks,  taking  place  suddenly  be- 
tween one  day  and  the  next. 

The  syndrome  of  astasia-abasia  is  not  always  as  distinct 
as  in  these  two  cases.  One  sees,  on  the  contrary,  astasic  and 


OF   NERVOUS    DISORDERS          379 

abasic,  or,  rather,  stasophobic  and  basophobic,  symptoms  ac- 
companied by  other  nervous  or  neurasthenic  disorders. 

Let  us  take  an  example  of  this  direct  psychotherapy  per- 
taining to  motor  troubles,  complicated  with  some  other  nervous 

symptoms.  M.  Y was  a  lawyer  forty-six  years  of  age, 

of  good  constitution,  without  organic  disease,  and  intelligent. 
He  came  to  consult  me  in  1897.  He  had  for  twelve  years 
found  it  impossible  to  walk  for  more  than  a  few  minutes. 
He  could  stand  up  for  a  moment  only,  and  that  by  putting 
the  right  knee  on  a  chair  and  holding  on  to  its  back. 

He  had  suffered  somewhat  from  rheumatism  and  laryn- 
gitis, but  this  arthritic  tendency  was  only  slightly  marked  in 
him,  and  until  1884  he  had  been  perfectly  well.  It  was  then 
that,  in  consequence  of  a  violent  emotion  caused  by  a  fire,  he 
felt  a  certain  weakness  in  his  legs.  In  1886  he  went  through 
another  emotional  period.  He  almost  lost  his  position,  and 
immediately  this  weakness  in  his  legs  became  marked.  The 
death  of  a  brother  in  1887  gave  him  the  last  blow,  and  since 
then  the  weakness  has  made  continual  progress. 

"  My  walking,"  said  he,  "  which  then  could  be  kept  up 
for  ten  minutes,  went  down  to  seven  or  eight  minutes,  and 
now  it  is  seldom  that  I  can  walk  more  than  a  minute  at  a  time. 
In  addition  to  the  remedies  which  I  have  taken,  I  have  had  sea 
baths  (which  I  found  very  bad),  I  have  been  to  Neris  and 
to  Lamalou;  I  have  taken  treatments  of  hydrotherapy,  elec- 
tricity, massage,  and  magnetism.  I  have  been  cared  for  by 
homeopaths,  allopaths,  and  empiricists.  In  1890  a  damp  sheet 
brought  on  rheumatic  congestion  of  the  lungs,  and  since  then 
all  bathing  brings  on  congestion.  It  gives  me  twinges  and 
rheumatic  pains.  I  am  obliged  not  to  wash  myself  except 
with  alcohol,  for  I  have  such  a  fear  of  water.  I  have  had 
some  phosphaturia  and  slight  transient  albuminuria.  My  feel- 
ings, which  are  not  naturally  light  hearted,  have  become 
depressed. 

"  Then  came  the  absolute  impossibility  of  standing  still, 
even  for  four  or  five  seconds ;  but  I  could  stand  upon  one  leg, 
with  my  eyes  closed,  for  ten  or  fifteen  seconds,  as  physicians 
required  me  to  do  to  see  if  I  had  a  medullary  lesion.  It  was 


380  PSYCHIC  TREATMENT 

impossible  for  me  to  take  more  than  one  hundred  to  one  hun- 
dred and  fifty  steps  in  succession  and  impossible  to  take  more 
than  fifteen  hundred  to  two  thousand  steps  during  the  whole 
day.  After  each  walk  of  one  hundred  to  one  hundred  and 
fifty  steps  a  long  rest  was  necessary.  For  more  than  ten 
years  I  could  not  go  up-stairs  higher  than  the  first  story;  if 
I  had  to  go  farther  I  was  carried  in  a  chair.  It  was  impossible 
to  read  or  speak  in  a  clear  voice  for  more  than  a  few  moments, 
when  my  voice  would  grow  weak.  It  was  impossible  to  read 
a  few  pages  without  bringing  on  smarting  in  the  eyes  and 
troubles  with  the  sight. 

"  I  had  always  been  able  formerly  to  read  a  long  time  with- 
out fatigue,  but  I  began  now  to  have  less  power.  My  capacity 
for  work  was  very  much  diminished.  Nevertheless,  my  intel- 
lectual faculties  did  not  seem  to  be  lessened  in  any  degree. 

"  To  sum  up,  all  my  organs  were  weaker.  I  would  exhaust 
in  a  few  moments,  and  even  in  a  few  seconds,  the  strength 
which  others  could  draw  on  for  several  hours. 

"  My  intestines  had  been  for  a  year  in  a  very  bad  condition. 
I  had  rheumatic  enteritis,  which  was  relieved  only  after  very 
great  precaution.  There  were  several  years  when  spinach 
hurt  me.  I  could  not  eat  anything  fat,  and  beans,  peas,  cab- 
bage, and  sea  fish  were  forbidden.  After  a  year  a  milk  diet, 
which  I  liked  very  well,  did  me  harm.  Eggs  gave  me  trouble 
with  my  liver,  which  always  enlarged.  Various  diagnoses 
were  made,  showing  neurasthenia,  anemia  of  the  brain,  rheu- 
matism of  the  brain,  and  nervous  troubles. 

"  I  became  greatly  emaciated,  either  as  a  consequence  of 
my  intestinal  troubles  or  in  consequence  of  too  strong  mag- 
netic treatment,  and  I  lost  in  one  year  from  seventy-five  to 
eighty-five  pounds.  (The  patient  added  to  his  description 
a  calligraphic  table,  giving  his  weight  for  each  week  during 
the  year  1897.) 

"  Twice  in  a  pilgrimage  to  Lourdes  I  was  suddenly  able 
to  walk  for  a  quarter  of  an  hour  in  the  procession.  I  was 
able  to  do  as  much  the  next  day,  but  at  the  end  of  a  few  days 
this  improvement  disappeared.  The  second  time  I  was  able 
to  stand  up  and  walk  sixteen  minutes,  but  to-day  I  am  just 


OF  NERVOUS   DISORDERS         381 

where  I  was  before.  A  statement  of  my  cure  has  figured  in  the 
annals  of  Lourdes,  but  in  order  not  to  cast  any  aspersions 
upon  the  place  I  have  not  rectified  the  statement." 

It  was  in  this  condition  that  the  patient  came  to  me,  and 
I  might  as  well  tell  you  that  this  description,  taken  as  a  whole, 
permitted  me  to  make  a  sure  diagnosis  of  nervousness,  even 
without  a  clinical  examination,  so  completely  did  the  patient 
reveal  his  neurasthenic  and  hypochondriacal  mentality  by  his 
description  of  himself. 

1.  Our  patient  was  a  man  of  petty  interests  who  compla- 
cently described  his  trouble,  weighed  himself  every  week  for 
a  year,  and  copied  his  observations  on  a  large  sheet  of  paper, 
where  all  the  days  of  the  year  were  put  down.     It  was  an 
excellent  piece  of  calligraphic  work,  which  showed  with  what 
attention  the  patient  noticed  the  slightest  variations  in  weight. 

2.  He  noted  his  symptoms  year  by  year,  remarked  that  his 
parents  were   cousins,  noted  his   diseases  and  his  emotions 
which  seemed  to  him  to  have  played  an  etiological  role.    He 
did  this  work  spontaneously,  without  any  suggestion  on  the 
part  of  the  physician. 

3.  The  role  which  he  made  the  emotions  play  showed  the 
psychic  nature  of  his  trouble. 

4.  In  the  description  of  his  inability  to  walk  and  to  stand, 
the  patient  showed  the  characteristic  precision  of  the  neur- 
asthenic.   From  ten  minutes'  duration  his  power  to  walk  fell, 
little  by  little,  to  seven  or  eight,  then  to  three,  to  five,  and  at 
last  to  two  or  three  minutes!     A  weak  person  or  a  conva- 
lescent would  never  give  these  precise  figures. 

5.  As  for  standing,  he  was  just  the  same;  he  could  not 
remain  standing  for  more  than  four  or  five  seconds,  while 
with  his  eyes  closed  he  could  reach  ten  or  fifteen. 

6.  In  the  description  of  his  actual  condition,  which  he  sepa- 
rated correctly  fronrits  antecedents,  he  returned  to  the  ques- 
tion of  walking.     He  could  take  from  one  hundred  to  one 
hundred  and  fifty  steps  at  once,  and  from  fifteen  hundred  to 
two  thousand  in  a  day.    He  could  climb  to  the  first  story,  but 
if  he  needed  to  go  higher  he  had  to  be  carried.     The  fixed 
idea  of  helplessness  appears  here  in  all  its  distinctness. 


382  PSYCHIC  TREATMENT 

7.  This   obsession  of  helplessness   appeared   again  as  to 
reading  hi  a  loud  voice,  and  he  noted  in  large  letters :  "  Weak- 
ness of  the  Voice,"  "  The  Eyes  Tired  in  Writing,"  and  "  Weak- 
ness in  the  Eyes."     On  page  IV.    (in  Roman  numerals,  if 
you  please)  he  resumed :    "  Then  all  my  organs  were  in  a  very 
weak  condition." 

8.  Next  it  was  the  turn  of  the  intestines.     The  patient  had 
(rheumatic!)  enteritis,  which  characterizes  constipated  nerv- 
ous people.     The  assimilation  of  food  hurt  him,  and,  spon- 
taneously or  under  the  influence  of  physicians,  he  avoided 
various   foods.     Suffering  all   the  while,   he   grows   thinner. 
Here  we  have  the  same  old  story  of  nervous  dyspeptics. 

9.  He  summed  up  his  diagnostic  remarks,  and,  in  spite  of 
the  evidence  of  neurasthenic  symptoms,  they  indicated  to  him 
anemia  of  the  cord  and  rheumatism  of  this  organ — inverse 
suggestions. 

10.  At  last  at  Lourdes,  under  the  influence  of  his  sincere 
faith,  he  experienced  some  slight  improvement. 

When,  furthermore,  the  reflections  which  were  inspired  by 
these  ten  observations  were  corroborated  by  the  absence  of  all 
material  lesions  and  all  symptoms  of  cerebral,  medullary  or 
peripheral  affections,  the  diagnosis  becomes  clear.  The  pa- 
tient was  only  a  phobic  psychoneurotic  who  believed  in  the 
reality  of  his  helplessness — a  form  of  hypochondria. 

The  patient  came  to  me  admirably  prepared  to  submit  to 
psychotherapeutic  influence.  A  stepbrother  of  his  had  just 
undergone  the  same  treatment  with  complete  success.  A 
friend  had  derived  great  advantages,  if  not  a  cure,  from  it. 
The  patient  who  had  been  helpless  for  twelve  years  was  en- 
thusiastic over  the  idea  of  the  treatment,  and  saw  the  following 
dilemma :  "  Either  the  physician  will  send  me  away  and  I  shall 
be  lost,  or  he  will  keep  me  and  I  shall  be  cured !  "  After  a  short 
examination  I  was  convinced  what  to  do  and  kept  the  patient. 
I  was  then  assured  of  the  result. 

"  Well,"  I  said  to  him,  "  you  may  stay  and  you  will  be 
cured.  Here  are  the  measures  for  you  to  take : 

"  First — You  will  go  to  bed  for  six  weeks.  There  is  al- 
ways more  or  less  reality  in  such  conditions  of  exhaustion,  and 


OF  NERVOUS   DISORDERS         383 

it  is  wise  to  reduce,  for  a  time,  one's  expenses  to  the  minimum. 
The  diminution  of  bodily  weight  also  indicates  the  need  of 
complete  rest. 

"  Second — As  you  have  suffered  from  dyspeptic  troubles 
whose  more  or  less  psychic  origin  I  will  explain  to  you  at  the 
proper  time,  you  must  go  upon  a  purely  milk  diet  for  six  days, 
and  don't  let  me  hear  that  you  can  not  take  it;  for  milk  can 
always  be  taken.  After  these  six  days,  you  will  return  to 
your  hearty  and  varied  diet  without  any  choice  whatsoever, 
and  to  fatten  you,  you  will  take  milk  between  meals.  You 
look  at  me  with  a  skeptical  smile.  Do  not  do  so,  my  dear  sir; 
I  know  what  I  am  talking  about! 

"  Third — from  the  seventh  day  you  will  have  massage.  It 
is  not  an  indispensable  measure,  but  it  will  make  up  for  the 
movement  which  you  lack,  and  will  favor  intramuscular  and 
cutaneous  circulation. 

"  As  for  your  various  helplessnesses,  we  will  return  to  them. 
For  the  time  being  strengthen  yourself  by  reducing  your  ex- 
penses through  rest  in  bed,  and  at  the  same  time  increase 
your  receipts  by  overfeeding.  Go  along  these  lines  and  every- 
thing will  come  out  as  we  wish." 

From  the  third  day  of  this  rest  I  knew  my  patient  and 
his  intelligence  and  rectitude  of  thought  sufficiently  well  to 
dare  to  use  direct  psychotherapy  in  order  boldly  to  attack  his 
autosuggestions,  and  I  could  say  to  him :  "  You  have  before 
you,  in  short,  six  obstacles :  You  can  not  stand,  walk,  or  read ; 
you  can  not  eat  as  everybody  else  does ;  you  can  not  have  regu- 
lar evacuations;  and,  last,  you  can  not  succeed  in  gaining 
weight.  Well,  all  these  barriers  may  be  thrown  down,  or, 
rather,  they  have  no  height.  They  exist  only  in  your  thoughts ; 
they  are  like  the  chalk-line  on  the  floor  which  a  person  who 
is  hypnotized  can  not  step  over  because  he  is  willing  to  be- 
lieve that  he  is  powerless  to  do  so.  Think  of  it!  Your  cure 
depends  upon  this  conviction,  which  must  be  established  in 
you  and  which  you  must  never  let  go !  In  the  third  week  the 
patient  said  to  me: 

; '  Doctor,  three  of  the  barriers  are  already  thrown  down, 
or,  rather,  as  they  had  no  height,  I  have  overcome  them 


384  PSYCHIC  TREATMENT 

without  difficulty.  First,  to  my  great  astonishment,  I  was 
able  to  stand  the  milk  diet.  I  have  eaten  everything,  and  no 
one  of  the  foods  which  I  considered  indigestible  for  me  has 
done  me  any  harm.  Only  think  that  the  seventh  day  after 
my  milk  diet  I  ate  fish  and  mayonaise!  I  have  done  without 
them  for  twelve  years.  Then  my  stools  have  become  regular. 
I  have  established  a  daily  movement  at  a  regular  hour.  In 
short,  I,  who  for  years  have  tried  to  gain  weight  without  being 
able  to  do  so,  have  made  each  week  a  gain  of  five  pounds! 
But  what  still  troubles  me  is  standing  upright,  and  walking, 
and  reading.  I  am  not  sure  of  success  in  those  lines.' 

"  I  understand  you,"  I  said  to  him ;  "  these  are,  in  short,  the 
most  troublesome  symptoms  to  you.  But  remember  that  you 
have  no  organic  lesions,  that  you  are  only  nervous.  Believe 
me,  all  your  symptoms  are  tarred  with  the  same  brush.  They 
are,  if  you  will  call  them  so,  spots  of  the  same  ink.  If  you 
have  been  able  to  efface  three  of  them,  why  should  the  others 
resist?  Keep  this  idea  in  mind,  or,  if  you  like  it  better, 
that  of  the  chalk-line  upon  the  floor.  During  the  three  weeks 
which  still  remain  for  you  to  spend  in  bed  hammer  this  idea 
into  your  head.  Do  not  make  any  attempt  to  stand  up,  walk, 
or  read.  A  failure  would  discourage  you.  Get  these  con- 
trolling ideas  deeply  into  your  mind.  Become  imbued  with 
a  profound  conviction  of  cure." 

At  the  end  of  six  weeks  he  got  up,  and  from  the  first  day 
was  able  to  walk  two  hours.  He  could  read  an  entire  news- 
paper without  fatigue  and  without  his  eyes  smarting.  He 
could  stand  up  for  a  long  time,  altho  one  could  still  detect 
in  him  a  certain  fatigability  and  fear  of  standing  up. 

I  showed  him  the  psychic  nature  of  this  helplessness,  and 
enumerated  to  him  the  mental  pecularities  which  I  had  de- 
tected in  him.  He  confirmed  these  views  by  saying  to  me: 
"  I  have  noticed  how  much  there  is  in  an  idea.  Just  think ! 
Sometimes  when  I  went  out  of  my  office  into  the  room  where 
my  clerks  were  I  could  stand  up  very  well,  and  walk  if  the 
door  opened  easily.  But  my  limbs  would  immediately  sink 
from  under  me  if  the  lock  stuck  or  turned  with  difficulty.  I 


OF  NERVOUS  DISORDERS         385 

see  that  this  could  have  had  no  material  influence  upon  me; 
it  was  merely  an  idea." 

The  patient  went  away  cured  at  the  end  of  two  months' 
treatment.  I  have  kept  up  intimate  relations  with  him.  Not 
only  has  he  not  fallen  back  in  the  course  of  the  last  six  years, 
but  his  health  is  stronger,  and  he  is  a  man  who  occupies  a 
prominent  position  in  business  and  literary  affairs,  who  lives 
an  active  life,  and  who  has  shown  in  troubled  political  circum- 
stances a  courage  which  is  not  seen  every  day.  Sometimes 
he  has  had  some  waverings.  Standing  up  seems  to  have  been 
the  most  difficult  for  him;  the  patient  has  had  some  tendency 
toward  hypochondriacal  thoughts  and  detected  enlargement 
of  the  veins  of  the  foot  after  standing  for  a  long  time,  but 
a  letter  from  me  was  enough  to  dispel  these  symptoms. 

Altho  having  no  uneasiness  on  the  subject  of  these  slight 
returns,  I  have  thought  that  I  ought  to  indicate  to  him  by  a 
letter  or  in  friendly  conversation  the  inconveniences  of  this 
restless  state  of  mind.  "  Take  care,"  I  said  to  him ;  "  you  are 
intelligent,  you  think  correctly,  and  it  is  to  these  qualities  that 
you  owe  your  cure.  You  have  a  certain  logical  turn  of  mind 
which  has  led  you  altogether  astray  when  you  have  started 
off  on  false  premises  or  hypochondriacal  autosuggestions.  It 
led  you  to  your  cure  the  moment  when  you  changed  your 
point  of  departure  and  were  able  to  see  the  ideogenic  nature 
of  your  troubles.  But  be  on  your  guard;  you  are  somewhat 
superstitious  and  you  are  a  little  cowardly;  you  have  not 
sufficient  contempt  for  your  body.  When  there  is  no  organic 
affection  (and  you  certainly  have  none),  health  depends  first 
of  all  upon  the  imperturbable  confidence  which  one  has  of 
possessing  it.  Beware  of  yourself,  for  your  cowardliness 
could  do  you  a  bad  turn  some  day. 

An  incident,  which  fortunately  was  transient,  came  to  con- 
firm these  fears,  and  to  contribute  to  strengthening  the  mental 
health  of  my  patient.  In  September,  1902,  he  underwent  some 
emotional  strain,  and  overworked  himself  in  publishing  a  book, 
into  which  he  had  put  his  whole  mind  and  which  required 
great  moral  courage  on  his  part.  He  was  seized  with  head- 
ache and  felt  as  tho  his  head  were  empty,  and  he  was  frightened 


386  PSYCHIC   TREATMENT 

by  this  weakness.  I  received  a  discouraging  letter  from  him. 
Knowing  me  to  be  upon  my  vacation,  he  had  not  wished  to 
depend  upon  me;  he  dreaded  calling  in  a  physician  for  fear 
he  would  give  him  medicines,  and  hesitated  about  consulting 
an  alienist,  lest  he  should  consider  him  foolish.  So  he  wrote 
to  a  somnambulist,  who  declared  that  his  condition  was  very 
serious — that  it  could  not  be  anything  but  softening  of  the 
brain,  which  would  end  in  madness.  You  can  imagine  how 
much  this  diagnosis  would  disturb  a  patient  who  was  always 
hypochondriacal  and  disposed  to  magnify  his  troubles.  Hence- 
forth he  held  back  no  longer,  but  confided  his  weaknesses  to 
me.  I  replied  to  him  by  reassuring  him,  and  making  him 
notice  his  tendency  to  superstition,  to  that  irrationalism  which 
drove  him,  an  intelligent  and  cultivated  man,  to  have  recourse 
to  a  somnambulist. 

Scarcely  had  he  read  my  letter  than  he  set  himself  to 
work.  He  came  to  see  me  a  few  days  later  to  revive  his 
psychotherapeutic  principles,  and  from  that  time,  in  spite  of 
many  emotions  and  difficulties,  he  succeeded.  I  am  persuaded 
that  he  will  not  fall  back  again. 

Here  we  have  a  patient  reduced  to  utter  helplessness  for 
twelve  years,  after  having  resisted  the  therapeutic  efforts  of 
many  distinguished,  devoted,  and  energetic  physicians,  who 
had  recognized,  altho  with  many  sorry  hesitations,  the  patient's 
neurasthenia.  Why  were  these  confreres  not  able  to  succeed 
during  these  twelve  years  of  the  disease,  and  why  should  the 
patient  have  been  cured  in  a  few  weeks? 

They  did  not  succeed  because,  in  spite  of  all  their  experi- 
ence and  their  theoretical  knowledge,  they  were  not  sufficiently 
imbued  with  the  idea  that  nervousness  is  psychic  in  its  nature ; 
because  they  hesitated  in  the  diagnosis,  seeking  a  medullary 
affection  when  the  psychoneurosis  was  evident;  because,  im- 
bued with  the  ideas  of  the  relationship  between  nervousness 
and  arthritism,  they  attributed  to  the  latter  some  of  the  symp- 
toms; because,  in  speaking  of  rheumatism,  they  thus  gave 
a  certain  reality  to  the  ills  of  the  body  and  admitted  to  him 
their  physical  nature.  In  short,  because,  much  as  they  wished 
to  reach  the  desired  end,  and  to  have  recourse  to  moral  influ- 


OF  NERVOUS   DISORDERS         387 

ence,  they  did  not  quite  know  how  to  direct  it  in  order  to  make 
it  efficacious.  They  were  not  able  to  transmit  their  convic- 
tion because  it  was  not  sufficiently  clear  and  complete  in  their 
own  minds. 

I  led  the  patient  to  a  rapid  and  decided  cure  without 
having  recourse  to  any  new  physical  measure  and  without  a 
single  medication.  The  patient  was  pleased  to  give  me  his 
complete  confidence.  This  was  not  a  blind  faith  but  a  reason- 
ing faith,  because  he  had  just  seen  two  patients  who  were 
cured.  That  was  a  perfectly  rational  induction. 

He  stayed  in  bed  six  weeks.  At  the  same  time  I  did  not 
think  that  I  could  attribute  any  decided  influence  to  this  rest. 
But,  above  all,  I  had  succeeded  in  persuading  him  that  he 
would  be  cured ;  that  he  could  eat  without  fear ;  that  he  could 
strengthen  himself  and  regulate  his  daily  movements.  I  did 
not  hesitate  to  tell  him  that  his  difficulty  in  walking  was  a 
pure  basophobia,  that  his  lack  of  power  to  read  rested  equally 
on  purely  mental  representations.  I  made  him  put  his  finger 
on  his  cowardliness  and  his  irrationalism,  and  I  corrected  this 
mentality  by  conversation. 

This  was  the  efficacious  proceeding,  and  it  is  easy  to  em- 
ploy, but  on  the  condition  that  one  thinks  clearly  and  follows 
the  right  road.  With  all  grown  people  I  have  recourse  only 
to  this  direct  psychotherapy  without  any  subterfuges.  It  is 
not  necessary  that  my  patient  should  be  educated  or  have  any 
philosophic  culture.  The  workman  and  the  peasant  under- 
stand with  great  acuteness  the  influence  of  the  moral  on  the 
physical,  provided  that  one  takes  the  trouble  to  explain  it  to 
them  clearly  in  terms  which  are  familiar  to  them. 

In  these  treatments  the  patient  and  the  physician  seem  to 
work  to  obtain  the  same  result — the  one  by  his  confidence  and 
his  good  sense,  the  other  by  his  clear  and  convincing  expla- 
nation of  the  matter.  It  is  a  great  mistake  of  logic  to  use 
any  material  methods  of  treatment  in  such  cases  other  than 
those  prescribed  by  hygiene.  Medical  intervention  is  wholly 
psychic,  and  it  is  on  account  of  forgetting  this  idea  that  so 
many  patients  have  years  of  suffering  and  often  incurability. 


388  PSYCHIC  TREATMENT 


CHAPTER   XXX 

Example  of  Psychic  Treatment  in  a  Case  of  Psychoneurosis  with  Mul- 
tiple Symptoms — Nervous  Pains  Cured  by  Suggestion — Value  of 
Direct  Psychotherapy — Utilization  of  the  Stoic  Idea;  Seneca  — 
Pelvic  Neuralgia  Cured  by  these  Measures 

IN  the  cases  which  I  have  just  described  we  have  seen 
a.  series  of  nervous  symptoms  cease  under  purely  psycho- 
therapic  influences.  Nervousness  is,  in  fact,  rarely  mono- 
symptomatic,  especially  if  one  analyzes  the  mental  state  of  the 
subject,  and  if  one  takes  the  mental  symptoms  into  account. 

These  results  are  particularly  instructive,  for  they  show 
that  this  therapy  ought  to  be  directed  to  a  single  end,  to  at- 
tacks not  only  on  the  symptoms,  but  the  mental  disorder  which 
produces  them.  That  is  why  I  insist  so  upon  this  point  and 
allow  myself  to  describe  again  a  typical  observation  of  nerv- 
ousness with  multiple  symptoms.  Madame  V was  a  lady 

forty  years  of  age  who  was  sent  to  me  as  a  desperate  case 
by  a  physician  who  was  a  stranger  to  me. 

Very  intelligent,  but  endowed  with  disordered  sensibility 
and  a  vivid  imagination,  she  had  had  an  unhappy  existence. 
Her  conjugal  life  had  been  profoundly  troubled ;  she  lived  apart 
from  her  husband.  Already  subject  to  nervous  troubles,  and 
to  attacks  of  psychic  depression,  she  had  seen  her  condition 
grow  worse  after  the  birth  of  her  daughter.  Under  the  in- 
fluence of  fatigue  and  emotions,  she  had  fallen  into  a  psycho- 
pathic condition  with  predominant  hysterical  symptoms  with 
almost  permanent  states  of  astasia-abasia,  crises  of  contrac- 
ture,  pains,  and  various  paresthesiae.  She  had  passed  through 
several  attacks  of  delirium. 

For  about  nine  years  sh«  had  undertaken  various  treat- 
ments and  rest  cures,  according  to  Weir  Mitchell,  and  treat- 


OF  NERVOUS   DISORDERS         389 

ments  at  high  altitudes.  She  had  exhausted  the  whole  series 
of  antispasmodics. 

Five  years  before,  starting  from  the  false  idea  that  hysteria 
is  a  morbid  entity,  and  that  it  had  a  genital  origin,  her  physi- 
cians had  removed  the  uterus  and  ovaries.  This  intervention 
had  only  produced  a  fresh  recurrence  of  psychopathy.  In  the 
course  of  the  last  year  she  had  had  recourse  to  injections  of 
strychnine.  (Parenthetically,  I  wonder  of  what  use  it  is  thus 
to  poison  psychopaths?) 

The  patient  was  so  afflicted  during  the  last  months  that 
she  was  obliged,  on  several  occasions,  to  postpone  the  journey 
she  wished  to  take,  and  came  to  me  in  a  special  car  in  a  state 
of  utter  helplessness. 

On  her  arrival  I  observed  that  the  patient  was  in  a  good 
state  of  nutrition,  and  did  not  complain  of  any  symptoms  which 
could  make  me  suspect  an  organic  affection.  The  psycho- 
pathic condition  stared  me  in  the  face,  and  I  noticed  the  fol- 
lowing symptoms:  (i)  Complete  astasia-abasia,  without  any 
symptoms  of  paralysis,  properly  so  called.  There  was  in 
dorsal  decubitus  a  certain  weakness  of  the  lower  extremities, 
but  the  energy  of  the  movements  would  be  sufficient  to  permit 
her  to  stand.  (2)  Impossibility  of  sitting  down,  partly  on 
account  of  muscular  weakness  and  partly  for  fear  of  pains 
in  her  back.  (3)  Asthenopia,  preventing  reading  and  writing. 

(4)  Photophobia,   obliging  the  patient  to  draw  the  curtain 
and  turn  a  mirror  to  the  wall  because  its  light  hurt  her. 

(5)  Sensibility  to  cold  to  such  a  degree  that  on  a  warm  day 
in  June  she  enveloped  her  head  in  a  woolen  scarf. 

In  the  presence  of  these  symptoms  of  complete  exhaustion 
of  long  standing,  I  grasped  the  difficulties  of  the  task  from 
the  start,  and  conceived  the  plan  of  proceeding  slowly  from  the 
rest  cure  and  isolation  to  moral  orthopedia,  which  alone  was 
indicated.  Knowing  that  the  patient  had  shown  a  repugnance 
to  the  idea  of  submitting  to  any  suggestive  influence,  I  feared 
to  wound  her  by  going  too  quickly,  and  in  the  first  interview 
I  avoided  all  allusion  to  the  psychic  origin  of  nervousness. 

But  the  next  day,  in  conversation  with  my  amiable  and 
very  intelligent  patient,  I  immediately  departed  from  this  use- 


390  PSYCHIC  TREATMENT 

less  diplomacy.  I  burned  my  vessels  behind  me,  and  in  the 
space  of  half  an  hour  set  forth  my  views  on  the  purely  mental 
nature  of  all  these  states  of  helplessness.  As  I  had  expected, 
judging  by  my  already  lengthy  experience,  the  patient  ac- 
cepted without  any  difficulty  these  statements,  which  knocked 
down  the  whole  scaffold  of  her  old  convictions  as  tho  it  were 
a  castle  made  of  cards.  She  essayed  a  timid  defense  concern- 
ing some  details.  I  relate  this  incident  here  in  spite  of  its 
insignificance,  because  it  characterizes  my  manner  of  proceed- 
ing. The  patient  asked  me  to  renew  her  supply  of  Hoffman's 
anodyne,  pretending  that  she  found  a  great  deal  of  relief 
in  her  spasmodic  attacks. 

I  said  to  her :  "  I  will  prescribe  this  anodyne,  but  you 
must  permit  me  to  tell  you  that  I  do  not  believe  at  all  in  its 
efficacy.  You  could  replace  it  by  cold  water  or  take  nothing 
at  all.  The  medicine  can  only  act  upon  your  trouble  by 
suggestion." 

The  patient  protested  a  little,  and  wanted  to  prove  to  me 
the  absence  of  all  suggestion  by  the  following  reasoning: 
"  My  physician,  in  whom  I  have  great  confidence,"  she  said, 
"  has  at  different  times  prescribed  medicines.  He  has  praised 
the  effects  to  me,  and  I  assure  you  that  I  have  taken  them  with 
the  profound  conviction  that  they  would  do  me  good.  They 
had  no  effect.  A  little  later  he  gave  me  the  Hoffman  drops 
with  an  air  as  much  as  to  say :  '  Try  them,  they  can  not  do  you 
any  harm.'  I  recall  having  been  affected  by  the  contagion 
of  this  skepticism;  nevertheless,  the  drops  did  do  me  great 
good!" 

"  Well,  madam,  you  reply  to  me  as  many  physicians  do, 
and  you  are  mistaken  just  as  they  are.  You  imagine  that 
suggestion  proceeds  by  conscious  syllogisms,  and  that  one  has 
faith  when  one  wants  to  have  it.  But  it  is  often  born  with- 
out our  knowledge  and  in  spite  of  our  skepticism,  which  is 
wholly  on  the  surface  before,  during,  or  after  medication,  es- 
pecially when  a  strong  improvement  due  to  other  causes  coin- 
cides with  the  taking  of  the  remedy.  Then  the  bond  of  cause 
and  effect  is  established,  and  henceforward  you  have  all  the 
effects  of  the  medicine  that  you  expect.  Believe  me,  your 


OF  NERVOUS   DISORDERS         391 

trouble  is  psychic,  entirely  psychic,  and  you  have  no  need 
of  material  treatment." 

The  patient  did  not  insist,  and  in  a  quiet  voice,  scanning 
the  question  as  if  to  fix  her  ideas,  said  to  me:  "You  believe, 
then,  that  I  could  read,  write,  and  stand  the  daylight  if  I  had 
the  inner  conviction  that  I  could  do  all  that  ?  " 

"  Yes,  you  have  good  eyes ;  the  oculist  has  told  you  so. 
I  do  not  see,  then,  why  you  could  not  read.  The  nervous  as- 
thenopia,  as  we  call  it,  has  never  been  anything  but  a  con- 
viction of  powerlessness." 

"  You  also  believe  that  I  could  stand  upon  my  feet  and 
walk  from  the  moment  that  I  have  the  conviction  of  this 
power  ?  " 

"  Yes ;  you  have  no  paralysis,  nor  any  cerebral,  medul- 
lary, nor  peripheral  affection  which  would  hinder  you  from 
walking." 

"  Very  well ;  I  see  that  I  must  change  my  whole  manner 
of  looking  at  my  trouble.  Why  has  nobody  told  me  this 
before?" 

This  conversation  had  taken  place  on  a  Saturday.  On 
Monday  I  found  the  patient  sitting  up  in  bed.  She  held  in 
her  hand  a  letter,  which  she  had  written  to  her  mother  and 
which  she  was  rereading.  The  curtains  were  drawn,  letting 
the  daylight  come  in.  The  mirror  had  been  placed  in  its 
usual  position.  The  patient  had  taken  the  woolen  scarf  from 
her  head.  In  short,  she  smilingly  made  movements  in  her 
bed  to  show  that  she  meant  to  get  up  soon !  Three  days  after 
she  was  on  her  feet.  All  the  old  helplessness  of  nine  years 
standing  had  disappeared  under  the  influence  of  an  idea.  From 
that  time  the  patient  rapidly  returned  to  a  normal  life.  I 
dispensed  with  the  rest  in  bed  and  all  physical  measures.  The 
patient  went  out  and  applied  herself  to  the  reading  of  philo- 
sophical works,  requiring  a  real  mental  effort.  She  was 
cured,  and,  feeling  confidence  in  her  logical  mentality  and  in 
her  fine  mind,  I  felt  no  fear  for  her  future. 

It  is  evident  that  this  patient  could  have  been  cured  by 
the  same  means  at  the  beginning  of  her  trouble.  It  would 
have  been  enough  to  tell  her  the  truth  and  to  encourage  her. 


392  PSYCHIC  TREATMENT 

She  was  as  intelligent  as  she  was  tractable.  But  altho  the 
diagnosis  of  hysteria  was  made — that  is  to  say,  the  most  mental 
of  all  diseases — recourse  had  been  had  to  physical  measures, 
even  to  ovariotomy! 

Have  I  not  the  right,  in  establishing  this  therapeutic  inno- 
vation, to  repeat,  as  a  "  Leitmotif,"  this  truth :  "  For  psychic 
diseases,  psychic  treatment  "  ? 

All  that  I  have  said  concerning  lack  of  power  of  all 
kinds  applies  equally  to  the  pains  which  constitute  one  of 
the  most  frequent  symptoms  of  the  psychoneuroses.  It  is 
wise  to  remember  that  pain  is,  in  the  last  resort,  a  sensation 
which  can  only  be  perceived  by  the  ego.  It  is  a  purely  psychic 
phenomenon.  Just  as  we  have  the  right  to  consider  as  psy- 
chical all  troubles  of  motion  which  can  not  be  explained  by 
organic  lesions  or  by  intoxication,  so  we  may  suspect  the 
mental  origin  of  a  pain  when  by  conscientious  and  repeated 
examinations  we  are  unable  to  discover  its  cause. 

In  many  patients  the  absence  of  lesions  is  easy  to  ascertain, 
and  the  etiology  and  the  presence  of  other  psychic  symptoms 
are  sufficient  to  establish  a  certain  diagnosis. 

But  the  diagnosis  is  not  enough;  it  is  necessary  that  the 
therapeutic  measures  should  be  adopted  to  the  conception  that 
they  are  based  on  pathogeny.  That  is  something  that  is 
often  forgotten. 

A  little  boy  ten  years  of  age  twisted  his  foot  while  playing 
with  his  comrades.  He  went  home  hopping  on  one  foot,  and 
several  physicians  were  called  in,  one  after  another.  All  rec- 
ognized, in  short,  that  there  was  no  definite  lesion,  but  be- 
fore the  patient  they  mentioned  several  hypotheses ;  they  spoke 
of  effusion,  of  arthritis,  of  periostitis,  and  they  applied  local 
remedies — cold  compresses  and  tincture  of  iodine.  The  pain 
only  got  worse.  It  was  no  longer  localized  in  the  joint;  it 
extended  to  the  skin,  which  was  sensitive  to  the  slightest 
chafing;  the  patient  could  not  bear  even  the  weight  of  a  light 
sheet.  In  spite  of  that,  note  this  characteristic  detail:  The 
boy  did  not  stay  in  bed ;  he  wanted  to  go  out,  and  for  several 
weeks  he  entered  into  the  plays  of  his  comrades  by  jumping 


OF  NERVOUS   DISORDERS         393 

about  on  his  well  foot.  This  is  a  mental  state  which  is  for- 
eign to  patients  who  have  a  sprain. 

For  ten  weeks  there  was  no  improvement,  and  they  brought 
the  patient  to  a  surgeon.  He  soon  recognized  the  integrity 
of  the  joint  and  the  ligaments,  and  made  the  diagnosis  of 
articular  neurosis.  Do  you  think  that  he  was  about  to  have 
recourse  to  psychic  treatment?  Oh,  no;  he  prescribed  injec- 
tions of  carbolic  acid  and  application  of  a  constant  current 
of  50  milliamperes !  The  injections  were  made;  they  only 
produced  a  sloughing,  which  complicated  the  situation.  As 
to  the  constant  current,  the  family  physician  had  the  good 
sense  not  to  try  it  in  the  prescribed  strength. 

When  I  saw  the  patient  seated  on  his  chair  I  noticed  the 
flaccidity  of  his  atrophied  left  limb;  it  measured  at  the  calf 
5  centimeters  less  than  the  right.  The  foot  hung  limp,  and 
in  a  seated  posture  the  patient  could  not  raise  it.  On  the 
examination-table  movement  was  possible,  and  the  electric  tests 
did  not  show  any  muscular  or  nervous  lesion.  The  little 
patient  was  afraid  of  being  touched,  even  when  the  skin  was 
slightly  brushed  just  above  the  ankle. 

There  was  no  doubt  about  it:  it  was  a  psychic,  or,  if  you 
like,  an  hysterical  case.  The  course  to  pursue  was  to  reas- 
sure the  patient  and  his  mother,  and  to  give  rise  to  the  con- 
viction of  cure.  It  was  useless  with  a  little  chap  of  his  age 
to  enter  into  a  dissertation  upon  pain.  It  was  simpler  to  state 
the  near  cure  and  to  do  something.  I  advised  daily  faradi- 
zation of  the  atrophied  muscle  for  eight  days.  Addressing  my- 
self to  the  mother  and  not  to  the  boy,  who,  however,  was  all 
sars,  I  said  to  her :  "  I  am  very  glad  to  be  able  to  tell  you 
that  there  is  no  lesion ;  it  is  purely  nervous,  and  at  the  end  of 
eight  days  your  boy  will  be  cured."  And,  in  fact,  he  was,  and 
could  walk  on  the  day  set.  The  atrophy  diminished  slowly, 
and  at  the  end  of  two  months  it  was  scarcely  noticeable. 

Here  is  another  case.  A  confrere  who  was  going  on  his 
vacation  sent  me  a  boy  who,  a  few  weeks  before,  had  fallen 
from  the  bar  on  which  he  performed  gymnastics.  He  had 
twisted  his  wrist,  and  it  showed  some  signs  of  synovitis.  Com- 
presses had  been  applied,  and  his  arm  was  put  in  a  brace. 


394  PSYCHIC   TREATMENT 

Actually  the  patient  carried  his  arm  in  a  sling,  and,  altho 
there  was  no  swelling  and  no  palpable  lesion,  the  skin  of 
the  arm  was  hyperesthetic  from  the  hand  to  the  crown  of 
the  shoulder.  This  was  a  phenomenon  foreign  to  trauma- 
tisms ;  such  hyperesthesia  is  a  mental  stigma. 

With  a  suggestive  intention,  I  held  several  seances  of 
Franklinization  (that  was  at  the  beginning  of  my  career,  and 
I  still  had  need  of  some  therapeutic  feints),  and  every  day 
before  anything  else  I  stated  that  there  was  an  improvement, 
and  that  the  skin  had  become  less  sensitive.  I  did  away  with 
the  sling,  and  placed  the  patient's  hand  in  his  vest.  The  next 
day  I  made  him  place  it  a  button  lower  down,  then  in  his 
belt,  and  at  last  in  his  pocket.  Thus,  in  a  few  days,  he  was 
cured,  and  he  showed  it  with  ostentation  by  jumping  over  a 
bar ;  he  remained  suspended  there  with  all  the  weight  of  .his 
body  bearing  on  the  member  which  he  had  not  been  able  to 
use  for  weeks.  In  these  two  cases  (which  have  to  do  with 
children)  I  profited  by  their  natural  suggestibility,  and  elec- 
trization only  served  me  to  give  them  a  plausible  idea  of  cure. 
To-day  I  could  do  without  the  suggestion.  I  never  employ 
it  in  adults.  Such  deception  makes  me  ill  at  ease,  and  I  al- 
ways prefer  to  set  my  views  as  frankly  before  my  patients 
as  I  would  do  before  a  confrere. 

I  do  not  hesitate  to  persuade  my  patients  to  neglect  the 
painful  phenomena.  The  idea  is  not  new;  the  stoics  have 
pushed  to  the  last  degree  this  resistance  to  pain  and  misfortune. 
The  following  lines,  written  by  Seneca,1  seem  to  be  drawn  from 
a  modern  treatise  on  psychotherapy: 

"  Beware  of  aggravating  your  troubles  yourself  and  of 
making  your  position  worse  by  your  complaints.  Grief  is 
light  when  opinion  does  not  exaggerate  it;  and  if  one  en- 
courages one's  self  by  saying,  '  This  is  nothing,'  or,  at  least, 
'  This  is  slight ;  let  us  try  to  endure  it,  for  it  will  end,'  one 
makes  one's  grief  slight  by  reason  of  believing  it  such."  And, 
further :  "  One  is  only  unfortunate  in  proportion  as  one  be- 
lieves one's  self  so." 


1  QSuvres  completes  deSenfcque(lephilosophe).  LeiireLXXVlH.  b  LuciKut.  Paris. 


OF  NERVOUS   DISORDERS          395 

One  could  truly  say  concerning  nervous  pains  that  one 
only  suffers  when  he  thinks  he  does.  I  could  quote  numer- 
ous examples  which  show  the  possibility  of  suppressing  more 
or  less  rapidly  and  often  once  for  all  such  painful  phenomena. 
I  will  only  cite  one,  in  which  the  cure  was  rapidly  obtained 
after  eleven  years  of  suffering. 

Mme.  A ,  the  wife  of  a  physician,  was  thirty  years 

of  age,  and  had  enjoyed  good  health  until  her  nineteenth 
year.  Her  father,  sixty-seven  years  old,  had  had  during  his 
whole  life  a  tendency  to  melancholia.  He  was  eccentric,  self- 
willed,  and  paradoxical.  The  paternal  grandmother  had  suf- 
fered from  melancholia.  The  mother  died  of  cardiac  trouble 
at  forty-three  years  of  age,  probably  from  cerebral  embolism. 

At  nineteen  years  of  age  the  patient  noticed  that  after 
having  worked  with  her  needle  her  eyes  were  irritated  and 
tearful.  The  oculist  made  the  diagnosis  of  asthenopia  from 
error  of  accommodation,  and  prescribed  glasses.  The  sudden 
death  of  her  mother  prevented  the  patient  from  following  her 
treatment  and  provoked  new  symptoms.  Under  the  effect 
of  emotion  the  patient  perceived  that  she  could  not  move  her 
eyes ;  they  were  fixed.  She  also  had  palpitations  and  digestive 
troubles.  The  asthenopia  increased :  she  experienced  a  painful 
tension  around  her  eyes  and  in  the  ala  of  the  nose,  chiefly  on 
the  right  side.  The  death  of  her  mother  made  the  father  still 
more  peculiar,  and  this  sad  life  began  to  aggravate  the  nerv- 
ousness which  was  already  evident  in  the  patient. 

Another  oculist  found  no  lesion,  but  made  an  unfortunate 
suggestion  by  saying :  "  You  will  always  be  a  mystery  for 
the  physicians !  "  It  is  not  always  well  to  say  all  that  one 
thinks. 

Her  engagement  being  opposed  by  her  rather  selfish  father, 
her  marriage  was  delayed  for  more  than  three  years.  A  third 
oculist  spoke  of  nervous  contracture,  and  expressed  the  opinion 
that  a  change  of  life — for  example,  a  happy  marriage — could 
bring  about  a  complete  change — a  characteristic  word  in  the 
mouth  of  the  specialist  always  ready  to  localize  the  trouble, 
and  which  shows  the  psychic  nature  of  this  asthenopia. 

She  married  in  this  condition,  always  suffering  from  her 


396  PSYCHIC   TREATMENT 

eyes,  and  from  palpitations,  digestive  troubles,  and  stomachic 
vertigo.  She  took  a  wedding  journey  of  three  or  four  months 
suffering  still  more,  and  returned  enceinte. 

Her  pregnancy  was  accompanied  by  digestive  troubles  and 
swelling  of  the  neck  and  the  fear  of  going  alone  in  the  street — 
all  symptoms  which  belong  in  the  nervous  class. 

Already,  during  her  journey,  she  had  found  it  impossible 
to  eat  at  meal-time ;  on  the  contrary,  in  the  interval  she  would 
experience  sudden  feelings  of  hunger  with  sensations  of  ver- 
tigo, which  obliged  her  to  take  some  food.  This  condition 
continued  until  her  delivery.  A  breech  presentation  and  un- 
easiness provoked  by  her  accoucheur,  who  diagnosed  a  tumor, 
made  her  fear  an  abnormal  fetus,  a  monster,  and  she  could 
not  rid  herself  of  these  fears.  The  delivery  was  with  for- 
ceps. There  were  uterine  cramps  with  pains  analogous  to 
those  which  characterized  the  actual  condition. 

After  the  delivery  there  was  improvement — so  much  so 
that  the  patient  for  a  month  could  believe  herself  cured ;  but 
when  she  tried  to  walk  she  experienced  sharp  pains  in  the 
lower  part  of  the  abdomen,  and  was  treated  by  her  husband 
for  metritis.  The  condition  was  still  further  aggravated  by 
the  fatigue  brought  on  by  the  care  which  she  gave  to  a  sick 
child. 

At  the  end  of  a  year  she  consulted  a  celebrated  accoucheur, 
who  noted  endometritis  with  right  salpingitis.  Treatment  by 
caustic  pencils  was  without  success.  Then  she  had  recourse 
to  another  gynecologist  who  declared  that  his  confrere  was 
an  ass,  denied  endometritis,  but  admitted  a  left  salpingitis, 
declaring  that  she  never  would  be  cured.  This  is  what  we 
call  inverse  suggestion!  Then  followed  vesicants.  Since 
then  the  pains  have  persisted,  and  during  her  eleven  years  of 
marriage  the  patient  has  never  been  able  to  stand  a  walk  of 
more  than  ten  or  fifteen  minutes.  If  she  wanted  to  go  farther 
she  was  overtaken  with  intense  pains  in  the  lower  abdomen, 
chiefly  on  the  right  and  then  on  the  left.  She  kept  up  the 
continual  use  of  vesicants. 

Another  physician  made  the  diagnosis  of  enteroptosis  with 


OF  NERVOUS   DISORDERS         397 

prolapse  of  the  uterus  and  prescribed  pessaries  and  a  Glen- 
ard's  belt. 

New  emotions  appeared,  with  broncho-pneumonia  in  her 
child  and  angina  pectoris  in  her  father,  who  was  always  ec- 
centric and  bad  tempered.  Continued  and  varied  treatments 
were  taken  from  1892  to  1902. 

In  1898  an  excellent  physician  diagnosed  pelvic  neuralgia, 
and  for  seven  weeks  made  her  take  the  following  treatment: 
Hydrotherapy,  internal  massage,  electricity,  cauterization  of 
the  cervix,  application  of  ice  to  the  vertebral  column,  and 
suspension. 

At  the  start  he  gave  her  strong  hopes  of  cure,  but  was 
obliged,  to  his  great  regret,  to  conclude  that  she  was  incurable. 
In  1900  a  celebrated  physician  declared,  after  an  examination 
of  a  few  moments,  that  the  condition  was  incurable,  and, 
without  conviction,  advised  a  new  pregnancy.  This  happened, 
in  fact,  but  it  only  made  the  patient's  state  worse. 

In  1902  a  physician  recognized  (at  last!)  the  neurosis,  and 
prescribed  frequent  purging,  vesicants  applied,  sometimes  to 
the  nape  of  the  neck  and  sometimes  under  the  arm!  (This 
is  something  that  ought  to  cure  a  neurosis!) 

I  saw  the  patient  at  the  end  of  June,  1902.  She  was  a 
strong  woman,  in  a  good  state  of  nutrition,  which  from  the 
start  contraindicated  treatment  by  overfeeding.  I  noticed 
immediately  that  her  look  was  a  little  dazed  and  a  little  nerv- 
ous, that  she  was  voluable  in  her  expression  of  her  sufferings, 
and  that  she  was  impressionable,  for  she  described  as  very 
moving  several  events  of  no  particular  importance.  That 
very  morning  she  had  gone  out  to  attend  mass  and  was 
obliged  to  return  home  on  account  of  her  pains.  I  recog- 
nized, in  briefly  questioning  her,  various  symptoms  of  nerv- 
ousness, psychopathic  heredity,  and  the  influence  of  emotions, 
nervous  asthenopia  from  the  age  of  nineteen,  successive  ag- 
gravations under  the  influence  of  fatigue  and  emotions,  palpi- 
tations, dyspepsia,  vertigoes,  and  aggravation  of  these  troubles 
in  her  pregnancy  with  the  phobia  of  going  alone  in  the  street. 
All  that  was  the  history  of  a  nervous  person.  As  to  the  pains 
in  the  pelvis,  it  is  probable  that  they  were  nervous  also,  as 


398  PSYCHIC   TREATMENT 

none  of  the  diagnoses  made  before  had  indicated  a  precise 
lesion  and  several  physicians  had  qualified  the  disease  of  the 
pelvic  as  neuralgic. 

But  I  could  not  be  sure  upon  this  point  without  examina- 
tion and  I  begged  my  confrere,  Dr.  Conrad,  to  give  me  his 
advice  on  the  case.  He  replied,  after  two  complete  examina- 
tions :  "  This  patient  has  no  sign  of  gynecological  affection. 
The  uterus  and  its  appendages  are  intact.  There  are  two 
neuralgic  points,  the  one  on  the  posterior  face  of  the  body  of 
the  uterus,  the  other  on  the  posterior  face  of  the  neck.  These 
points  are  very  localized,  extremely  painful  to  the  touch,  but 
it  is  impossible  to  discover  a  lesion.  We  are  forced  to  admit 
in  these  cases  a  neuralgia,  and  experience  has  shown  us,  alas ! 
that  these  troubles  do  not  yield  to  local  treatment.  From  the 
gynecological  point  of  view,  however,  they  are  very  rebellious, 
and  I  believe  that  the  general  treatment  of  nervousness  would 
be  in  order  here.  In  order  to  avoid  provoking  the  pain  I 
should  even  consider  it  wise  to  give  up  making  local  exami- 
nations." 

Strengthened  by  these  instructions,  I  was  able  to  say  to 
the  patient :  "  You  have  suffered  for  ten  years  from  this  in- 
ability to  walk.  During  ten  years  you  have  exhausted  all  the 
resources  of  physical  and  pharmacotherapy.  The  very  failure 
of  these  attempts  should  not  discourage  you,  for  discourage- 
ment leads  to  nothing,  but  it  shows  you  that  you  have  been 
on  the  wrong  path.  We  must  cease  to  treat  the  body  which 
is  healthy;  it  is  a  question  of  the  mind.  Your  whole  trouble 
is  nervous — that  is  to  say,  psychic.  I  will  show  this  to  you  little 
by  little  in  the  course  of  the  treatment.  Your  whole  history 
from  nineteen  years  of  age  has  been  that  of  a  nervous  person 
dominated  by  feelings  of  helplessness  and  neuralgias  without 
evident  lesion.  Moreover,  you  have  the  psychotherapic  he- 
redity and  I  often  find  you  in  moods  of  depression." 

During  the  first  three  weeks  I  had  much  trouble  to  make 
her  understand  me.  The  patient,  who  was  intelligent,  did  not 
oppose  my  deductions  by  rational  objections,  she  did  not 
quibble;  but  she  believed  herself  incapable  of  having  been 
mistaken  by  her  pains,  and  chiefly  she  feared  that  she  would 


OF   NERVOUS   DISORDERS          399 

never  escape  from  the  bondage  of  her  melancholy  feelings. 
Each  morning  she  awoke  troubled  and  anxious,  and  could  not 
remember  the  advice  which  she  had  accepted  the  evening  be- 
fore, and,  as  in  conditions  of  melancholia,  the  idea  of  incura- 
bility persisted. 

This  struggle  would  have  perhaps  discouraged  me  fifteen 
years  ago,  but,  persuaded  that  I  had  to  deal  with  a  pure  psy- 
choneurosis,  and  proving  the  helplessness  of  physical  treat- 
ment, I  felt  the  necessity  of  pursuing  my  psychotrerapeutic 
task  without  respite  and  without  truce. 

When  it  was  time  to  make  a  plan  of  treatment  I  had  to 
know  how  to  persist  with  an  imperturbable  obstinacy.  I  had 
to  know  how  to  silence  her  fears,  and  teach  her  not  only  not 
to  show  them,  but  not  to  have  them.  One  must  desire  the 
cure  of  his  patient  and  believe  that  he  desires  it.  When  one 
has  succeeded  in  creating  this  state  of  mind,  one  does  not  let 
one's  self  be  thwarted  by  a  few  weeks  of  failure,  and  in  the 
end  one  has  the  happiness  of  seeing  the  fulfilment  of  the  cure. 

I  put  the  patient  to  bed  for  six  weeks,  but  said  that  I 
did  not  count  at  all  on  this  means  to  cure  her.  I  only  had 
recourse  to  it  to  avoid  for  her  the  possibility  of  attacks  of 
pain  as  movement  brought  them  on.  I  insisted  on  making 
her  understand  that,  in  any  neuralgic  conditions  whatsoever, 
it  is  always  to  one's  interest  to  diminish  the  number  of  attacks 
in  order  to  combat  the  tendency  to  repetition.  I  made  no  pre- 
scription of  diet  and  I  left  the  patient,  whose  weight  was 
normal,  free  to  eat  what  she  wanted  to. 

I  had  her  take  a  slight  massage  of  the  extremities  to  im- 
prove the  circulation,  only  attributing  to  this  measure  the 
slightest  importance  from  the  therapeutic  point  of  view.  The 
treatment  consisted  wholly  in  clear  conversations  on  the  nature 
of  nervous  phenomena  and  on  the  influence  of  the  moral  on 
the  physical.  I  did  not  fear  to  combat  the  confidence  which 
she  might  still  preserve  in  physical  means  by  reminding  her 
of  past  failures  and  I  sought  to  give  her  a  new  faith — that  of 
treatment  of  the  mind. 

When,  at  the  end  of  a  few  weeks,  she  came  out  a  little 
from  the  state  of  melancholic  confusion  which  had  hindered 


400  PSYCHIC  TREATMENT 

her  at  first  from  following  the  conversation,  I  led  her  to  higher 
considerations,  insisting  on  the  necessity  of  constant  courage 
and  stoicism.  Our  conversations  bore  on  altruism,  on  the 
danger  that  there  is  in  always  thinking  of  one's  self.  A  more 
complete  understanding  was  established  between  us.  The 
hope  of  cure  grew  in  the  mind  of  the  patient  who  at  first 
had  seemed  so  rebellious. 

In  the  seventh  week  she  got  up,  still  a  little  fearful.  She 
went  out,  and  forced  herself  to  walk,  disregarding  the  pain, 
and  at  the  end  of  a  few  days  of  exercise  she  undertook  to 
climb  on  foot  a  little  mountain  about  1700  feet  high.  After 
that  her  cure  was  assured.  The  patient  took  a  journey,  say- 
ing that  she  stood  it  without  any  difficulty,  and  returned 
cured  of  this  pelvic  neuralgia,  which  had  been  declared 
incurable. 

From  the  start  the  patient,  delivered  from  her  pains,  still 
suffered  from  an  unhappy  state  of  mind  and  a  tendency  to 
melancholia,  and,  fearing  for  her  sanity,  I  felt  that  I  ought  to 
call  her  husband's  attention  as  a  physician  to  this  mental 
state,  which  was  of  more  importance  in  my  eyes  than  the 
neuralgic  symptoms. 

Three  months  afterward  he  announced  to  me  that  the 
neuralgia  had  not  reappeared,  that  the  patient  could  lead  a 
normal  life,  and  that  little  by  little  she  was  coming  out  of 
that  mental  state  of  depression  which  was  so  distressing. 

I  saw  the  patient  a  year  later.  She  had  always  been  well, 
and  did  not  complain  of  anything  except  her  mental  condi- 
tion, which  was  not  as  strong  as  she  wished  it  to  be.  How- 
ever, she  was  living  a  normal  life,  after  having  been  for  eleven 
years  condemned  to  rest.  She  will,  I  am  sure,  lose  this  native 
psychasthenia  which  has  made  her  existence  so  painful,  in 
spite  of  all  the  elements  of  happiness  which  life  has  offered 
to  her. 


OF  NERVOUS   DISORDERS         401 


CHAPTER   XXXI 

Analysis  of  a  Case  of  Hysteria  with  Multiple  Symptoms  —  Disastrous 
Effect  of  Wavering  in  the  Diagnosis  and  of  Local  Treatment — Only 
a  Direct  and  Frank  Psychotherapy  Puts  an  End  to  the  Vagaries  of 
the  Disease — Recent  Progress  of  Psychotherapy — Buttei  sack,  of  Berlin 
— The  Works  of  D.  P.-E.  Levy,  of  Paris— The  Education  of  the 
Will — Necessity  of  Holding  to  Psychotherapy  Pure  and  Simple 

THOROUGHLY  to  appreciate  the  value  of  a  psychothera- 
peutic  treatment  one  should  be  able  to  follow  the  patients  and 
be  present  at  the  conversations.  One  would  then  see  what  a 
physician  can  obtain  by  a  word  and  a  smile,  and  would  admit 
this  extreme  "  impressionability  "  of  the  mind,  which  is  a  fault 
when  it  creates  unhealthy  autosuggestions,  but  a  precious 
quality  when  it  leads  to  cure. 

I  would  like  to  try,  by  analyzing  a  few  complex  cases,  to 
give  an  idea  of  this  wholly  moral  therapy.  In  April,  1902,  I 
•received  from  a  very  distinguished  confrere  a  letter  in  which 
he  recommended  to  me  a  young  woman  thirty-one  years  of 
age  afflicted,  he  said,  with  a  serious  hysteria  which  he  had 
treated  for  four  years. 

He  indicated  the  hereditary  effects  and  the  evident  nerv- 
ousness of  the  mother  and  summed  up  his  observations  in 
these  words :  "  I  have  had  evidence  from  the  start  of  gastric 
troubles,  with  such  intense  cardialgia  that  I  have  been  obliged 
to  diagnose  an  ulcer  of  the  stomach;  but  the  usual  treatment 
had  no  success,  and,  returning  to  the  hypothesis  of  a  general 
and  special  gastro-intestinal  neurasthenia,  I  cared  for  the  pa- 
tient for  eight  weeks  in  a  sanitarium.  There  was  improvement, 
and  an  increase  of  weight  from  ninety-two  to  one  hundred 
pounds,  but  she  remained  amyasthenic  and  suffered  incessantly 
from  cardialgia.  The  treatment  was  hydrotherapy,  massage, 


402  PSYCHIC   TREATMENT 

electrization,  and  diet.  The  symptoms  persisted;  constipa- 
tion was  always  marked  with  violent  enteralgia  in  the  region 
of  the  colon,  extending  to  the  sigmoid,  typical  muco-mem- 
braneous  colitis,  less  pain  in  the  stomach,  but  more  in  the 
abdomen,  thighs,  and  knees. 

In  1899,  considering  isolation  to  be  favorable,  she  was 
sent  to  a  foreign  sanitarium.  The  intensity  of  her  pains,  the 
swelling,  constipation,  and  thinness,  led  the  physician  to  the 
diagnosis  of  tuberculous  peritonitis.  He  diagnosed  some  ad- 
hesions, but  advised  against  any  operative  intervention  and 
contented  himself  with  enemas  of  oil,  and  narcotics. 

On  her  return  home  the  family  physician  could  not  agree 
to  this  diagnosis  and  asked  for  a  consultation  with  two  other 
confreres,  one  of  whom  was  a  skilful  surgeon.  They  thought 
of  nervousness,  but  did  not  completely  exclude  the  diagnosis 
of  a  lesion.  Thus,  when  the  patient  declared  that  she  wished 
to  make  an  end  of  it,  and  when  she  asked  for  operative  inter- 
vention, they  made,  to  be  sure,  an  exploratory  incision,  es- 
tablishing the  integrity  of  all  the  organs.  There  was  a  rapid 
cure  of  the  operated  region  without  any  relief  of  the  pains. 

In  the  summer  of  1899  she  took  sea  baths  and  douches 
without  success.  The  hysterical  condition  became  more 
marked.  There  was  pain  on  the  lower  part  of  the  abdomen 
to  the  left,  anesthesia  of  the  skin  of  the  body,  and  irradiation 
of  pain  alongy  all  the  limbs.  It  was  difficult  for  her  to  take 
food  and  she  became  emaciated,  her  weight  falling  to  one 
hundred  and  ten  pounds.  The  patient  in  this  condition  spent 
three  winters  in  complete  rest  in  the  country,  in  a  family 
where  she  was  comfortable.  Her  condition  remained  station- 
ary. Her  constipation  was  obstinate,  so  that  she  often  had 
only  one  movement  a  week,  in  spite  of  enemas  and  laxatives. 
The  insomnia  increased  day  by  day.  A  gynecological  con- 
sultation was  held  without  any  result. 

In  the  summer  of  1900  she  underwent,  without  improve- 
ment, and  rather  with  aggravation,  a  prolonged  treatment  in 
a  sanitarium  for  nervous  patients.  They  there  found  perma- 
nent pains,  stubborn  constipation,  anesthesia  of  the  whole  body, 
except  the  hands,  the  soles  of  the  feet,  and  in  the  neighborhood 


OF   NERVOUS    DISORDERS          403 

of  the  wound  of  the  laparotomy,  where  there  was  hyperesthe- 
sia;  also  bilateral  contraction  of  the  visual  field.  The  physi- 
cian recognized  hysteria  and  asked  himself  how  this  person, 
who  seemed  so  well  endowed  from  the  mental  point  of  view, 
could  happen  to  have  a  major  neurosis.  He  discovered  as  a 
provoking  cause  the  grief  of  having  lost  two  friends  and 
fright  caused  by  a  fire  three  years  before. 

He  made  a  great  many  examinations  of  the  rectum,  elec- 
tricized  that  organ,  and  gave  lavage  of  the  stomach  to  cause 
contractions.  At  last  he  tried  hypnosis  and  found  the  patient 
hypnotizable  but  not  suggestible.  Any  posthypnotic  sugges- 
tion did  not  act,  and,  at  the  end  of  about  five  seances,  the  patient 
showed  some  fear  in  connection  with  this  proceeding.  At  last 
he  had  recourse  to  electric  baths  and  then  to  narcotics. 

The  patient  was  discouraged,  and  had  some  disagreeable 
experiences  with  her  nurse.  Then  the  pedagogical  idea  was 
broached,  and  the  favorable  influence  of  a  regular  occupation ; 
but  the  physician  seemed  to  be  at  his  wits'  end,  and  in  a 
pessimistic  letter  he  dismissed  his  patient,  all  the  while  telling 
her  how  sympathetic  he  had  found  her. 

In  the  summer  of  1901  she  was  in  the  same  condition, 
hysterical  aphonia  having  lasted  some  weeks.  New  treatments 
were  tried  without  any  hope  on  the  patient's  part. 

The  physician  who  sent  her  to  me  saw  her  in  October,  1901, 
and  indicated  a  localized  meteorism  at  the  left  iliac  fossa,  where 
the  colon  could  be  felt  to  be  distended.  The  region  was  pain- 
ful to  the  touch  and  they  came  back  to  the  idea  of  peritonitis. 
She  took  a  treatment  of  rest  and  poultices.  Then  she  made 
a  new  visit  to  the  country  where  she  enjoyed  perfect  quiet 
but  where  she  always  was  in  pain.  After  she  had  lain  for 
half  an  hour  on  a  steamer-chair  in  the  open  air  she  was  over- 
come with  incredible  fatigue  and  a  feeling  of  exhaustion  which 
lasted  for  five  or  six  hours. 

"  You  are  going  to  say  that  this  is  nervousness,"  she  wrote 
to  her  physician,  "  but  that  does  not  hinder  it  from  being  ex- 
tremely painful."  It  was  only  in  bed  that  she  felt  any  better. 
She  was  discouraged,  and  wrote,  while  thanking  her  physician 
for  his  devoted  care :  "  I  hope  that  you  may  never  have  in 


404  PSYCHIC   TREATMENT 

the  future  a  patient  who  is  so  difficult  as  I  am !  "  At  last, 
in  a  postscript,  the  physician  continued:  "Objective  gastric 
symptoms;  mucous  catarrh  without  chemical  disturbance  or 
disturbance  of  motility.  Intestinal  symptoms  with  muco- 
membraneous  enteritis.  Finally  anemia." 

It  was  in  this  distressing  state,  lasting  six  months,  and 
which  always  grew  worse  in  spite  of  therapeutic  intervention, 
that  I  took  the  patient  for  treatment. 

This  information  was  sufficient  to  enlighten  me  as  to  the 
diagnosis,  and  the  only  interest  I  had  in  the  first  interview 
was  to  see  whether  the  patient  was  well  disposed,  and  confi- 
dent, and  of  sufficient  rational  understanding  to  understand 
me.  At  the  end  of  a  half-hour's  conversation  I  was  reassured 
on  this  point,  and  I  could  say  to  the  patient :  "  You  will  be 
cured;  there  is  not. the  slightest  shadow  of  doubt  of  that  for 
me." 

On  the  second  visit  I  made  a  new  examination  which 
confirmed  the  diagnosis.  I  learned  the  following  antecedents : 
Good  health  until  twenty-five  years  of  age,  save  excessive 
impressionability.  Gastric  troubles  and  fatigue  following  the 
death  of  two  friends.  On  the  occasion  of  a  slight  fire  caused 
by  her  brother  who  came  home  late,  intoxicated,  she  was 
frightened,  and  since  then  had  persistent  fear  of  fire  which 
kept  her  from  sleeping.  At  last,  as  an  aggravating  cause, 
came  her  experience  of  failure  in  therapeutic  measures  and 
the  variations  in  the  diagnosis. 

But  the  patient  was  intelligent  and  high  minded.  She 
showed  confidence.  That  was  all  that  was  necessary  to 
prophesy  a  good  result.  The  clinical  examination  showed: 
emaciation,  cutaneous  anesthesia  of  the  trunk  and  of  the  limbs, 
chiefly  on  the  left  side ;  pain  in  the  left  iliac  fossa,  relieved  by 
poultices;  great  pain  on  the  pressure  and  great  pain  also  by 
the  simple  pinching  of  a  fold  of  skin!  Palpation  did  not 
indicate  any  alteration  of  the  intestine  or  of  the  ovary;  the 
exploratory  laparotomy  had,  however,  shown  the  integrity 
of  the  organs. 

Hence  I  stated  that  the  whole  trouble  was  nervous,  that 
there  was  no  lesion,  and  that  it  was  all  absolutely  curable. 


OF  NERVOUS   DISORDERS          405 

I  put  my  patient  to  bed,  prescribed  for  her  a  milk  diet,  and 
told  her  to  keep  in  her  mind  the  following  reflections :  "  My 
trouble  is  purely  nervous;  the  doctor  has  told  me  that  in  his 
dictionary  the  words  '  nervous '  and  '  curable '  are  always 
joined  together.  I  will  live,  then,  in  this  happy  hope — no,  in 
this  certainty — of  cure !  " 

The  patient  immediately  began  bravely  to  drink  her  milk 
and  the  first  week  gained  a  pound  in  weight.  Her  nights 
improved.  She  slept  half  an  hour,  then  three  hours,  then  five 
hours.  Often,  after  a  passable  night,  there  would  come  a 
bad  night  and  the  patient  would  say  to  me :  "  When  I  can  not 
sleep,  then  I  am  agitated  and  I  can  not  fall  asleep  again."  I 
profited  by  this  confession  in  order  to  expound  the  psychology 
of  sleep  to  her. 

I  exhausted  this  subject  in  a  long  conversation,  showing 
the  patient  that  to  seek  for  sleep  was  only  to  drive  it  away, 
as  she  herself  had  found  out.  I  went  into  all  the  details, 
analyzing  the  physical  and  psychical  causes  of  insomnia.  The 
patient  understood  me.  The  nights  became  better ;  she  ate  well, 
and  without  complaining  of  dyspepsia.  But  the  constipation 
persisted  and  every  two  days  she  had  to  have  recourse  to  a 
large  enema.  But  from  the  start  I  succeeded  in  suppressing 
all  preoccupation  on  the  subject  of  constipation  by  telling  her: 
"  You  do  not  have  to  concern  yourself  about  it.  Under  the 
influence  of  overfeeding  and  of  observing  a  fixed  hour  you 
may  have  a  movement  spontaneously,  so  that  everything  will 
be  all  right;  or  you  may  not  have  to  succeed,  for  we  have  an 
enema  to  fall  back  upon  which  will  always  work.  In  all  ways 
free  yourself  from  anxiety.  Do  not  let  us  talk  any  more  about 
this  symptom !  You  shall  only  tell  me  when  you  have  regular 
movements,  that  will  not  keep  you  back."  From  that  day  the 
phobia  of  constipation  ceased,  altho  success  was  delayed  and 
it  was  only  at  the  end  of  seven  weeks  that  the  first  sponta- 
neous evacuation  came. 

The  most  distressing  symptom  was  the  pain  in  the  left 
iliac  fossa  which  was  often  accompanied  by  a  swelling.  I 
admitted  to  the  patient  that  this  symptom,  when  it  had  been 
still  more  marked,  could  have  led  the  physician  to  a  diagnosis 


406  PSYCHIC   TREATMENT 

of  peritonitis,  but  that  a  later  observation  had  shown  that  it 
was  only  due  to  a  nervous  peritonitis.  I  continued  to  state 
that  it  was  nervous  and  curable.  I  told  her  of  the  cases  in  my 
clinic  which  had  been  cured  and  showed  her  examples  of 
emotional  diarrhea,  tachycardia,  nausea,  and  vomiting,  born 
under  the  influence  of  a  pure  mental  representation,  the  action 
of  the  idea  on  our  functions.  At  the  same  time  I  made  her 
notice  the  regular  gain  in  weight,  and  told  her  that  she  looked 
better  in  her  face,  which  was  true.  Assured  myself  that 
she  would  be  cured,  I  had  no  difficulty  in  transmitting  my 
conviction  to  her  by  a  sort  of  moral  contagion. 

What  is  more  she  accepted  all  these  councils.  Without 
any  concern  for  her  gastric  disorders  she  took  three  full 
meals  a  day  with  milk  between  times.  She  made  herself  go 
to  the  toilet  regularly  every  day  at  a  stated  time  to  make  an 
effort.  She  no  longer  troubled  herself  about  her  insomnia; 
in  short,  with  a  joyful  sort  of  stoicism  she  neglected  her  pains, 
being  sure  that,  as  they  were  no  longer  due  to  organic  disease, 
she  had  nothing  to  fear,  and  was  persuaded  that  one  could  set 
up  a  moral  resistance  against  pain  which,  when  it  was  due  to 
nervousness,  would  become  a  source  of  cure. 

Every  day  I  returned  to  this  psychotherapic  instruction, 
sometimes  happening  to  do  so  in  conversation  on  these  sub- 
jects, sometimes  summing  up  the  ideas  and  recommending 
them  to  the  meditation  of  the  patient,  giving  her  her  task 
for  the  day.  Once  I  would  tell  her,  for  example,  to  let  her 
mind  dwell  on  these  few  simple  and  clear  ideas :  "  First,  my 
whole  trouble  is  nervous — that  is  to  say,  psychic ;  and  as  there 
is  no  lesion,  my  condition  is  curable.  Second,  one  can  always 
place  one's  pains  on  a  lower  rung  of  the  ladder  of  evils  and 
can  at  last  manage  voluntarily  to  forget  them." 

Not  only  did  the  patient  accept  this  idea  without  protes- 
tation, but  with  exceeding  fineness  of  psychological  analysis, 
she  criticized  it,  and  said  to  me :  "  Is  the  expression  quite 
right  when  you  say  '  forget  them  voluntarily  '  ?  It  seems  to 
me  that  when  one  fixes  one's  mind  on  anything,  one  can  not 
forget  it !  " 

"  You  are  right,"  I  said  to  her ;  "  there  is  a  certain  contra- 


OF  NERVOUS   DISORDERS         407 

diction  in  these  two  words.  It  is  a  little  as  if  one  tried  to 
catch  himself  not  thinking,  which  is  impossible,  for  then  one 
is  asking :  'Am  I  thinking  or  not  ? '  Or  else,  in  order  to 
take  a  still  grosser  comparison,  it  is  like  the  game  of  looking 
in  the  mirror  to  try  to  see  how  you  look  with  your  eyes  shut. 
Do  not  forget  your  pains  voluntarily,  but  accustom  yourself 
always  to  consider  them  as  slight,  and  then  you  will  quite 
involuntarily  forget  them,  for  one  neglects  what  has  no  im- 
portance." 

Without  dreaming  that  she  herself  had  had  aphonia  I 
quoted  to  her  the  case  of  an  hysterical  aphonia  which  I  had 
cured  in  three  days  by  simply  turning  the  patient's  thought 
away  from  this  symptom.  She  understood,  but,  like  the  ma- 
jority of  nervous  people  she  did  not  want  to  admit  the  same  in- 
fluence in  her  own  case. 

"  My  aphonia,"  said  she,  "  did  not  have  the  same  origin ; 
it  was  due  to  an  autosuggestion.  I  had  even  forgotten  this 
symptom  and  I  was  not  at  all  discouraged  by  it.  But  suddenly 
having  upset  a  cup  of  tea  in  my  bed,  I  could  not  raise  my 
voice  to  call  to  my  sister." 

"  Pardon,  you  had  not  forgotten  your  aphonia.  At  the 
moment  of  that  accident  you  were  seized  with  two  contra- 
dictory ideas — on  the  one  hand,  the  desire  to  call  out,  and, 
on  the  other,  the  conviction  that  you  could  not  do  it.  If  you 
had  truly  forgotten  your  aphonia  you  could  have  spoken." 

The  treatment  followed  its  course  without  other  psychic 
measures  than  rest  (which  she  had  tried  before  without  suc- 
cess), overfeeding,  and  general  massage — all  being  useful 
auxiliaries,  but  they  could  not  bring  about  a  cure. 

Every  effort  bore  upon  the  mind  and  on  the  morale.  It 
was  necessary,  not  only  to  dispel  the  numerous  autosugges- 
tions and  convictions  of  helplessness,  but  to  arouse  her  moral 
energy,  and  to  teach  the  patient  to  take  life  in  another  way, 
and  adapt  herself  to  circumstances. 

The  patient  grew  stronger,  regained  her  embonpoint  and 
no  longer  complained  of  pains.  She  was  able  to  act  like  a 
healthy  person,  to  go  and  come,  read  and  work.  Her  diges- 
tion was  good,  her  movements  became  regular,  and  she  was 


408  PSYCHIC  TREATMENT 

almost  cured  when  she  left  the  sanitarium — three  months  after 
her  arrival.  Since  then  she  has  continued  to  live  an  almost 
normal  life. 

Undoubtedly  she  was  not  wholly  cured.  She  remained  in 
the  good  condition  of  nutrition  to  which  I  had  brought  her; 
she  was  active  and  worked  like  a  healthy  person,  and  in  the 
eyes  of  her  family  she  could  pass  as  cured.  But  I  still  found 
in  her  a  tendency  to  insomnia,  a  slight  pain  (which  she  did 
not  notice)  in  the  left  iliac  fossa,  and  always  a  certain  emo- 
tional tendency  and  too  great  an  impressionability.  And,  lastly, 
she  had  not  been  able  wholly  to  free  herself  from  the  fear 
which  she  had  on  the  subject  of  a  possible  fire  when  her 
brother,  who  was  always  somewhat  unsteady,  came  home  late. 
It  must  not  be  forgotten  that  she  was  an  old  maid,  and  that 
she  lived  in  a  nervous  environment.  But  the  success  was 
none  the  less  evident. 

Why  should  the  patient,  who  in  three  months  had  almost 
reached  a  cure,  have  seen  her  condition  remain  so  long  with- 
out improvement,  even  grow  worse  during  the  six  preceding 
years,  and  during  treatments  which  she  had  received  from 
physicians  whose  competence  and  devotion  I  recognized? 

The  cause  of  the  lack  of  success  is  the  same  as  in  the  cases 
which  I  have  pointed  out;  it  is  the  absence  of  clear  views  on 
the  nature  of  nervousness.  At  the  start  the  diagnosis  made 
was  round  ulcer.  I  recognized  that  the  error  was  possible, 
and  in  no  wise  reproached  the  physician  for  having  made  it. 
But  however  excusable  our  errors  may  be  we  must  recognize 
that  they  are  often  fatal  to  the  patient.  The  failure  of  the 
cure  had  already  discouraged  the  patient.  Then  the  physician 
recognized  the  neurasthenia,  but  instead  of  having  seen  at  a 
glance  that  the  whole  thing  was  psychic,  he  spoke  of  general 
and  special  neurasthenia ;  he  was  haunted  by  the  idea  of  local- 
ized neurasthenia  in  the  nerves  of  the  stomach  and  he  always 
had  recourse  to  physical  measures. 

They  withdrew  the  patient  from  the  family  circle  and  a 
strange  physician  revived  the  fixed  idea  of  an  organic  trouble 
by  speaking  of  tuberculous  peritonitis.  There  again  I  do  not 
know  whether  or  not  to  reproach  the  physician  for  his  error, 


OF  NERVOUS   DISORDERS         409 

altho,  in  my  opinion,  it  might  have  been  possible  for  him  to 
avoid  it  and  to  have  recognized  the  hysterical  peritonitis. 

But,  pardonable  or  not,  this  diagnosis  was  not  favorable 
for  bringing  the  patient  to  a  sense  of  conviction  that  she  would 
be  cured.  In  the  consultation  of  the  three  physicians  the  idea 
of  hysteria  was  discussed,  but  they  were  still  doubtful,  and  let 
themselves  be  led  to  make  an  exploratory  laparotomy.  This 
proof  of  the  integrity  of  the  organs  might  have  been  useful. 
They  could  have  said  some  good  has  come  out  of  the  trouble ; 
but  they  did  not  know  how  to  take  advantage  of  it  in  order 
to  rid  the  patient's  mind  of  all  ideas  of  organic  affection. 

At  last,  in  a  sanitarium,  pure  hysteria  was  diagnosed,  but 
examinations  of  the  rectum  and  of  the  sigmoid  region  was 
continued,  and  enemas,  electricity,  and  massage  were  still 
employed.  Several  medicines,  even  narcotics,  were  experi- 
mented with.  At  last  the  patient  was  hypnotized,  but  was  not 
found  to  be  suggestible !  It  should  have  been  said  that  the  pa- 
tient accepted  the  suggestion  of  sleep  and  repulsed  that  of  cure. 
It  would  have  been  of  more  value  to  have  tried  this  latter 
upon  her.  And  then  it  would  have  been  easy  to  show  her  that 
there  was  nothing  the  matter  with  her. 

In  all  these  treatments  I  see  no  trace  of  direct,  open,  and 
convincing  psychotherapy,  which  is  the  only  efficacious  thing 
when  it  is  a  question  of  psychic  troubles. 

However,  the  light  is  dawning  little  by  little;  the  word 
"  psychotherapy  "  is  on  everybody's  lips.  Buttersack,1  at  Berlin, 
insists  on  the  moral  action  that  the  physician  can  and  ought 
to  exercise.  He  analyzes  minutely  the  origin  of  psychic  im- 
ponderable factors  and  recognizes  the  value  of  an  optimistic 
philosophy. 

A  Parisian  physician,  M.  Paul-Emile  Levy 2  has  for  a 
long  time  recommended  autosuggestive  processes  for  acting  on 
ourselves  and  our  mentality  in  such  a  way  as  to  suppress  dis- 
eases, and  to  substitute  for  them  the  desired  feeling  of  health. 


1  Phvsiologisclif  und  psychologische  Bemerkungen  eur  psychischen  Therapie.  Von  F. 
Buttersack.  (Die  deutsche  Klinik,  1903.1 

*  L' Education  Rationnelle  de  la  volonte  el  son  emplai  thirapeuiique.  Thfcse  de  Paris, 
1898. 


410  PSYCHIC  TREATMENT 

I  often  recommended  my  patients  to  read  this  book  on  rational 
education  of  the  will  when  they  are  sufficiently  advanced  to 
understand  it  and  to  apply  its  wise  councils. 

But  there  is  still  too  much  of  a  "  process  "  and  of  artifice 
in  the  methods  of  Dr.  Levy.  The  subjects  "  suggest "  things 
to  themselves.  There  is  a  sort  of  simulation  of  hypnosis. 
In  certain  cases  the  patient  places  himself  on  a  sofa,  and  puts 
himself  in  a  favorable  condition.  According  to  my  ideas, 
this  is  too  much  like  imitating  the  practises  of  the  hypnotist; 
we  recognize  in  him  a  pupil  of  Bernheim. 

I  would  like  to  see  a  pure  psychotherapy;  the  stoicism 
which  cures  ought  to  be  based  not  on  autosuggestions  which 
are  artificially  put  into  one's  mind  during  a  "  seance,"  but  on 
lasting  philosophical  views  which  can  serve  as  a  guide  in  life. 
From  this  point  of  view  I  still  prefer  to  recommend  to  the 
bravery  of  young  people  who  are  neurasthenic  the  work  of 
J.  Payot.1 

A  similar  evolution,  however,  is  made  in  the  thought  of 
Dr.  Levy.  He  insists  on  the  relation  of  the  physical  to  the 
moral  and  recommends  a  hygiene  for  the  mind. 

In  two  recent  communications  2  he  has  shown  the  advan- 
tage which  can  be  derived  from  clear  psychological  ideas  in 
the  treatment  of  patients.  In  his  analysis  of  the  phenomenon 
of  "  pain  "  he  notes  distinctly  the  amplification  which  the  suf- 
fering undergoes  under  the  influence  of  the  mentality  of  the 
subject;  he  insists  on  the  frequency  of  "nervous"  pain,  even 
when  it  is  provoked  by  a  lesion  and  even  when  the  subject  is 
free  from  symptoms  of  nervousness. 

In  two  cases  of  sciatica  he  obtained  cure  by  suggestive 
processes,  coupled  with  the  use  of  some  medicines,  making  an 
effort  to  suppress  the  patient's  fears  and  her  concomitant 
mental  states. 

It  was  good  psychotherapy,  whether  the  idea  of  suggestion 


1  J.  Payot.    Education  de  la  volonti  (Bibliotheque  de  Philosophic  Contemporaine). 

*  Surla  delimitation  du  nervosisme  a  frofos  de  filtment  douleur.  Communication 
faite  i  la  societe  de  psychologic.  (Juillet,  1901.) 

Traitement  et  guirison  de  deux  cos  de  sciatique  par  reeducation.  (Revue  generate  de 
Clinique  et  de  Therapeutique,  1902.) 


OF  NERVOUS   DISORDERS         411 

was  always  recognized  or  not.  I  have  often  said  that  one  can 
not  always  avoid  this  latter,  and  that  I  am  sometimes  obliged  to 
capture  the  patient's  confidence  in  a  somewhat  artificial  man- 
ner. But,  in  this  case,  I  am  not  wholly  satisfied  with  my  work, 
even  if  the  result  is  obtained.  I  always  prefer  the  clear  situ- 
ation, which  consists  in  resolutely  placing  the  problem  on  psy- 
chological ground. 

Without  cruel  indifference,  and  without  giving  the  patient 
cause  to  be  hurt  by  the  idea  of  being  considered  an  imaginary 
invalid,  I  lead  him  in  another  direction:  I  bring  him  to  an 
analysis  of  the  psychic  ego.  I  point  out  his  fears,  his  timidity, 
his  mistrust  concerning  the  means  which  have  been  proposed. 
Soon  it  is  the  patient  who  helps  me  in  this  examination  of  his 
mentality,  who  reveals  his  apprehensions  to  me,  and  recognizes 
that  they  have  retarded  his  cure. 

The  more  one  advances  in  age  and  in  experience,  the  more 
one  gives  up  medicinal  and  physical  agents,  excepting  in  cases 
where  they  find  them  to  be  truly  valuable.  There  is  no  longer 
any  need  of  all  these  little  medical  deceptions.  One  must  ap- 
parently advance  toward  the  patient  without  arms  in  order  to 
defend  him  against  sickness.  You  think  that  he  is  going  to 
be  alarmed  and  to  doubt  the  efficacy  of  your  protection!  Ah, 
no;  he  has  the  good  sense  to  think  that  as  you  are  not  armed 
from  head  to  foot  it  is  apparent  that  there  is  no  danger.  Phy- 
sicians should  reflect  a  little  on  the  efficacy  of  such  a  conviction. 


412  PSYCHIC  TREATMENT 


CHAPTER   XXXII 

Proofs  of  the  Value  of  Moral  Treatment  in  Psyconeurosei — Modifica- 
tions of  Mentality  a*  the  Result  of  Advice — Relation  of  a  Case  of 
Psychoneuroses  which,  Having  Resisted  Physical  and  Moral  Cure, 
was  Cured  in  a  Single  Day  by  Psychic  Influence — Divers  Cases  of 
Nervousness,  in  which  the  Cure  has  been  Obtained  without  Physical 
Means  (by  Psychotherapy)  in  the  Course  of  a  Few  Conversations 

I  SHOULD  be  drawn  too  far  away  if  I  tried  to  enumerate 
patients  with  psychoneuroses  who  were  cured  by  these  means 
and  to  analyze  the  psychology  of  all  these  patients.  I  am 
obliged  to  limit  myself  to  the  description  of  a  few  typical  ob- 
servations ;  they  seem  to  me  sufficient  to  indicate  to  such  phy- 
sicians as  are  endowed  with  some  perspicacity  the  path  which 
I  have  followed. 

The  majority  of  the  results  which  I  have  quoted  have  been 
obtained  under  the  favorable  conditions  of  rest  cure,  isola- 
tion, overfeeding,  and  massage.  I  have  taken  care  to  remark 
distinctly  that  I  only  look  upon  these  means  as  auxiliary  and 
that  I  attribute  the  cure  to  moral  treatment. 

But  I  foresee  an  objection.  Some  one  might  say  to  me: 
"  Yes,  the  results  are  striking ;  but  you  have  employed  various 
means  at  the  same  time,  and  nothing  can  prove  that  you  must 
rank  your  psychic  influence  as  of  the  first  importance.  You 
hold  physical  measures  too  cheaply  and  you  forget  that  others 
obtain  analogous  results  by  physical  and  medical  agents  with- 
out ever  dreaming  of  adding  psychotherapic  procedures." 

Yes,  I  know  it;  the  neuroses  were  cured  before  the  inter- 
vention of  rational  psychotherapy.  But  I  have  said  that  all 
treatment  exercises  a  suggestive  influence;  it  is  impossible  to 
eliminate  this  factor. 

On  the  other  hand,  I  have  seen  so  many  patients  cured 
by  the  means  which  I  have  set  forth  whose  nervousness  had 


OF   NERVOUS    DISORDERS          413 

resisted  the  usual  treatment,  that  I  am  forced  to  recognize 
the  power  of  psychic  treatment.  It  is  quite  possible  in  Weir 
Mitchell's  treatment  to  bring  into  play  both  physical  and  moral 
agencies.  Rest,  diet,  and  massage  can  only  act  slowly  and 
progressively;  one  must  wait  for  the  cure.  But  when,  from 
the  beginning  of  the  treatment,  or  during  its  course,  a  sudden 
improvement  takes  place,  following  a  conversation,  when  the 
patient  recognizes  himself  that  he  has  simply  yielded  to  good 
sense,  it  is  impossible  to  deny  this  moral  action. 

In  all  my  observations  I  have  noted  this  curative  influence 
of  the  idea.  Without  any  doubt,  rest  does  a  great  deal  of  good 
to  patients ;  isolation  may  give  them  moral  calm  and  eliminate 
hurtful  influences;  the  improvement  of  the  state  of  nutrition 
is  desirable.  But  it  is  by  persuasion  that  one  can  suppress 
fears,  forebodings,  and  the  fixed  idea  of  physical,  intellectual, 
and  moral  helplessness.  A  little  persuasive  eloquence  can 
bring  dyspeptics  not  only  to  eat  with  a  good  appetite  but  to 
digest.  By  the  councils  of  healthy  medical  philosophy  one  can 
cure  insomnia,  constipation,  emotional  tachycardia,  and  all  the 
other  symptoms  of  nervousness.  It  is,  in  short,  by  a  still 
higher  psychotherapy  that  one  is  able  to  give  the  patient  con- 
fidence in  himself,  and  that  one  can  lead  him  to  an  attitude 
of  brave  morality,  which  makes  him  able  to  avoid  a  recurrence 
of  his  trouble. 

The  rare  failures  of  psychotherapeutic  treatment  made  un- 
der favorable  conditions  may  sometimes  serve  to  demonstrate 
and  to  establish  the  value  of  psychic  influence. 

I  have  quoted  in  the  Revue  de  Medecine  x  the  following 
case:  A  few  years  ago  I  was  called  by  a  confrere  to  see  a 
lady  thirty-six  years  of  age,  who  for  several  years  had  suffered 
from  very  serious  gastro-intestinal  troubles,  complete  anorexia, 
coated  tongue,  pains  in  the  stomach,  nauseous  risings,  vomit- 
ings, obstinate  constipation,  alternating  with  a  clearing  out  of 
the  intestines.  She  suffered  from  intense  headaches  and  in- 
somnia, she  was  anxious  and  sad,  and  she  fairly  gloated  over 
the  recital  of  her  troubles ;  but  these  symptoms  had  been  rele- 

1  l/jco  citato. 


414  PSYCHIC  TREATMENT 

gated  to  the  second  place  by  numerous  specialists  who  had 
given  the  place  of  honor  to  the  universal  gastro-enteritis  of 
Broussais.  The  patient  was  treated  without  any  success  along 
the  line  of  lavage  of  the  stomach  and  of  the  large  intestine, 
and  by  stomachic  medication. 

I  was,  on  the  contrary,  struck  with  the  physical  condition 
of  the  patient.  She  had  the  characteristic  look  of  the  hysteri- 
cal person,  and  the  eye  that  was  both  vague  and  anxious. 
Without  neglecting  the  trouble  with  her  digestion,  she  dwelt 
upon  her  frightful  and  persistent  headaches  and  on  her  pre- 
cordial  anguish.  In  spite  of  insufficient  food,  she  had  pre- 
served a  certain  embonpoint.  She  was  not  anemic,  but  she 
had  been  amenorrheic  for  seven  months.  All  of  these  symp- 
toms had  happened  at  the  end  of  an  unfortunate  married  life 
which  terminated  in  divorce,  after  some  years  of  martyrdom. 
The  physician  who  cared  for  her  last  concluded,  as  I  did, 
that  she  had  nervous  dyspepsia  accompanied  by  an  hystero- 
melancholic  condition  and  did  not  hesitate  to  assign  the  pre- 
ponderating etiological  role  to  her  conjugal  unhappiness. 
After  a  trial  treatment  at  home  I  had  to  take  the  patient  to 
my  sanitarium  and  put  her  upon  my  usual  treatment. 

I  succeeded  very  well  at  the  start.  Her  digestive  functions 
were  reestablished  and  her  sleep  returned;  the  headaches  di- 
minished, and,  by  the  fifth  week,  I  began  to  hope  for  a  rapid 
and  complete  cure.  Suddenly,  under  what  influence  I  can  not 
tell,  the  patient  slipped  away  from  me  mentally;  she  became 
rebellious  and  less  accessible  to  my  psychotherapy;  there 
seemed  to  be  a  certain  coolness  between  us.  Then  her  look 
became  nervous,  and  in  a  few  days  I  saw  the  dyspepsia  in 
all  its  intensity  come  back.  Her  anxiety  reached  such  a  pass 
that  I  was  afraid  of  the  development  of  true  melancholia ;  her 
tongue  was  coated,  the  eructations  became  nauseous;  the 
stomach  was  dilated;  diarrhea  appeared,  carrying  off  the 
remnants  of  badly  digested  food  in  bursts  of  fetid  gases. 

Certain  tho  I  was  of  the  nervous  nature  of  the  disease,  I 
felt  somewhat  unsettled,  and  was  at  the  point  of  having  re- 
course to  the  stomach-pump  and  of  diminishing  her  food,  but 
I  did  not  have  the  courage  for  such  recantation — not  from  the 


OF  NERVOUS   DISORDERS         415 

puerile  fear  zl  acknowledging  an  error  in  diagnosis,  but  be- 
cause I  knew  the  failure  of  previous  attempts  along  these  lines, 
and  because  I  feared  to  lose  the  suggestive  influence  which 
seemed  to  me  to  be  necessary  in  order  to  reach  my  end.  I 
hesitated  so  much  that  the  patient  lost  confidence,  and  went 
away  without  having  received  any  benefit. 

I  learned  later  that  she  had  returned  to  her  old  idea  of 
the  gastric  origin  of  the  trouble,  that  she  had  fallen  into  the 
hands  of  cranks  with  chemical  theories  who  had  gone  back 
to  the  lavage  of  the  stomach  and  irrigation  of  the  intestines 
and  restricted  diet.  I  learned  also  of  the  failure  of  these 
continued  attempts  during  several  months  and  I  believed  my 
patient  to  be  lost.  About  a  year  later  the  fellow  physician 
who  had  sent  her  to  me  told  me  of  the  complete  cure  of  this 
patient  happening  suddenly  one  day  under  the  sole  influence 
of  a  change  in  her  state  of  mind.  The  patient  had  been  of 
luke-warm  faith  until  that  time,  when  she  had  entered  into  a 
Protestant  sect,  and  between  one  day  and  the  next  all  her 
troubles  ceased.  When  my  confrere  asked  her:  "And  you 
can  digest  anything,  even  solid  food  ?  "  she  replied,  with  an 
illuminating  smile :  "  Why,  certainly ;  these  foods  were  given 
to  us  for  our  good,  they  can  not  do  us  any  harm ! " 

The  cure  was  kept  up,  and  the  patient  herself  announced 
it  to  me,  attributing  it  solely  to  Divine  influence.  Disappointed 
as  I  was  at  first  in  witnessing  the  inefficacy  of  my  effort,  I 
could  not  help  but  congratulate  the  patient  upon  having  found 
her  health,  and  after  all,  for  my  personal  instruction,  I  am 
very  happy  that  she  recovered  it  by  this  wholly  psychic 
method. 

For  several  years  I  have  only  subjected  exhausted  and 
emaciated  patients  to  the  regular  treatment  in  my  sanitarium. 
I  do  not  permit  them  to  labor  under  the  slightest  delusion  in 
thinking  that  this  material  treatment  will  be  enough;  I  make 
every  effort,  on  the  contrary,  to  have  them  understand  that 
the  cure  is  possible  only  by  psychic  means. 

The  rapidity  with  which  their  change  of  mentality  is  made 
is  truly  astonishing.  Let  me  quote  a  few  examples.  M.  X. 
was  a  neurasthenic  of  forty  years  of  age  who  had  always 


416  PSYCHIC   TREATMENT 

been  easily  fatigued  and  whose  moods  were  slightly  hypo- 
chondriacal.  He  suffered  from  dyspepsia  and  often  from 
insomnia,  but  what  annoyed  him  most  was  his  sensitiveness 
to  noise.  The  noises  of  the  street  irritated  his  nerves  and 
gave  him  headache.  Finding  no  indications  for  Weir  Mitch- 
ell's treatment,  I  established  the  patient  in  a  boarding-house. 
Scarcely  had  he  come  there  than  he  began  to  complain.  There 
was  a  coppersmith  in  the  neighborhood  who  every  day  ham- 
mered his  brasses ;  the  patient  counted  the  blows  of  the  work- 
men, and  when  the  last  had  stopped  he  would  say  to  himself: 
"  It  is  going  to  begin  again !  "  There  were  a  great  many 
carts  which  passed  and  which  ground  on  the  gravel  of  the 
road.  That  was  unbearable.  At  night  there  were  dogs  which 
barked  at  the  moon  and  neighbors  who  came  home  late! 

It  was  with  an  accent  of  reproach  that  he  told  me  his 
annoyances,  for  he  had  warned  me  by  letter  several  weeks  in 
advance,  that  he  must  have  a  quiet  room. 

"  Monsieur,"  I  said  to  him,  "  I  have  no  other  room  at 
your  disposal,  and  if  you  will  take  my  advice  it  will  be  better 
to  stay  here.  I  will  acknowledge  to  you  that  even  if  I  had  a 
quieter  room  I  would  hesitate  to  give  it  to  you." 

"  Ah,  really,  it  is  not  very  amiable  of  you  to  say  that." 

"  Pardon  me,  you  misunderstand  the  meaning  of  my  words. 
You  want,  do  you  not,  to  get  rid  of  this  sensitiveness  to  noise 
which  has  tormented  you  for  so  many  years?  If  I  should  put 
you  in  a  chamber  of  luxurious  silence  you  would  suffer  less, 
but  when  I  let  you  come  out  you  would  be  still  more  sensitive ; 
you  know  that  when  we  have  been  in  the  dark  the  light  of  a 
candle  dazzles  us.  You  will  never  get  over  this  infirmity  by 
cultivating  your  hyperesthesia.  I  most  certainly  do  not  want 
to  exaggerate  things  and  I  have  no  intention  of  placing  you 
under  particularly  difficult  conditions,  as  in  a  noisy  house. 
But  the  retreat  which  I  offer  to  you  is  as  tranquil  as  the 
average.  You  will  find  noises  everywhere  resulting  from  the 
activity  of  your  fellows.  You  do  not,  however,  want  to  live 
the  life  of  a  hermit;  your  profession  requires  a  sojourn  in 
town.  What  will  become  of  you  if  you  do  not  know  how 
to  bring  back  your  sensibility  to  the  normal  condition  ?  " 


OF  NERVOUS   DISORDERS         417 

"  But  it  is  stronger  than  I.  My  auditory  nerves  are  en- 
dowed with  a  diseased  sensibility." 

"  You  are  wrong.  Your  auditory  acuteness  is  normal. 
It  is  not  your  ears  which  are  too  sensitive;  it  is  your  mind. 
The  noise  only  tires  you  because  you  pay  attention  to  it,  be- 
cause you  have  the  conviction  that  you  can  not  stand  it.  Just 
believe  me,  no  one  hears  anything  but  that  for  which  he  lis- 
tens (you  have  told  me  that  you  count  the  workmen's  blows)  ; 
no  one  sees  anything  except  what  he  looks  at ;  no  one  has  any 
sensations  except  those  to  which  he  pays  attention.  Un- 
doubtedly, if  the  noise  is  too  loud  and  the  light  blinding,  our 
attention  is  immediately  fixed,  and  I  will  not  ask  you  not  to 
tremble  if  a  bomb  bursts  beside  you.  But  the  noises  of  life 
are  inevitable  and  we  must  know  how  to  pay  no  attention  to 
them.  What  neurasthenics  lack  is  the  power  of  adaptation. 
Say,  then :  '  I  will  pay  no  more  attention  to  these  noises ;  they 
do  not  exceed  what  is  possible  to  bear.'  " 

At  the  end  of  three  days  my  patient  had  suppressed  this 
wholly  psychical  hyperesthesia  and  I  no  longer  had  to  concern 
myself  with  this  symptom.  This  sensitiveness  to  noise  is  fre- 
quent among  my  patients  and  I  have  always  succeeded  in 
making  it  disappear  by  such  advice.  It  is  often  the  same  way 
with  sensibilities  that  are  wholly  moral. 

Mile.  X.  was  a  governess  who  had  for  a  long  time  suffered 
from  dyspepsia  and  anorexia  and  who  had  lost  about  twenty- 
five  pounds  in  the  space  of  a  few  months.  She  had  a  slight 
infiltration  of  the  right  lobe.  I  immediately  insisted  upon  the 
necessity  of  overfeeding  and  I  prescribed  the  regime  of  three 
copious  meals  a  day  with  milk  at  ten  and  four  and  nine  o'clock. 
Noticing  her  impressionability  and  sadness,  I  found  out  some- 
thing about  her  situation  and  asked  her  if  she  was  happy  in 
the  place  which  she  held. 

"  No,"  said  she ;  "  I  have  to  stand  all  sorts  of  annoyances 
in  that  family  and  it  is  that  which  has  made  me  nervous." 

"  Would  you  not  like  to  change  your  position  and  find  a 
place  which  would  be  more  congenial  to  you  ?  " 

"Ah,  no,  I  do  not  want  to.  There  are  very  great  pecuniary 
advantages  in  this  position ;  we  spend  the  winters  in  the  south 


418  PSYCHIC  TREATMENT 

and  the  summers  in  the  country,  and  it  would  be  difficult  for 
me  to  find  a  better  place  from  this  point  of  view." 

"  Mademoiselle,  one  should  not  rest  between  two  chairs ;  it 
is  wise  to  sit  down  upon  the  better  one.  When  one  is  not  con- 
tent with  a  position,  one  changes  it  if  one  can.  If  that  is  not 
possible,  especially  when  there  are  very  good  reasons  for  hold- 
ing it,  one  keeps  it,  but  then  one  must  keep  it  with  good  grace. 
It  is  not  sullen  resignation  which  I  am  recommending  to  you, 
for  that  is  a  vice ;  it  is  adaptation." 

These  councils,  developed  in  a  single  but  lengthy  conver- 
sation, had  a  definite  effect.  The  patient  was  able  to  put  her 
overfeeding  into  practise  and  regained  her  lost  pounds.  She 
learned  also  to  accept  her  life  and  has  no  longer  had  any 
reason  to  complain  of  nervousness. 

Neurasthenic  physicians  are  in  general  more  stubborn 
than  all  other  human  beings ;  they  argue  and  oppose  me,  often 
with  the  whole  stock  of  their  preconceived  opinions.  There 
are,  nevertheless,  some  who  have  a  quick  perception.  A  con- 
frere wrote  to  me  from  a  resort  in  the  mountains.  He  had 
suffered  for  a  long  time  from  neurasthenia;  he  had  just  made 
a  long  sojourn  in  a  high  altitude  and  asked  me  what  other 
resort  I  could  indicate  to  him  for  neurasthenia. 

I  had  a  very  strong  desire  to  reply  to  him :  "  Neurasthenia 
is  a  psychic  disease;  it  may  be  treated  at  the  sea-level  just  as 
well  as  at  an  altitude  of  five  thousand  feet,"  but  fearing  to 
repulse  him  by  expressing  my  opinion  so  frankly,  I  begged 
him  to  come  to  see  me.  I  saw  him  at  the  hotel.  He  was  a 
strong  man,  in  a  good  state  of  nutrition,  without  organic 
lesions.  He  acknowledged,  moreover,  that  he  was  quite  well 
physically  and  only  complained  of  the  psychasthenia  which 
hindered  him  from  working.  In  spite  of  the  improvement 
which  he  had  made  he  seemed  to  believe  that  the  progress 
would  be  slow  and  that  it  was  in  physical  measures  that  he 
should  seek  the  remedy. 

After  a  personal  conversation  of  an  hour,  I  had  no  diffi- 
culty in  showing  him  the  mental  nature  of  his  helplessness,  of 
his  neurasthenic  weakness.  I  showed  him  that  he  lacked 
moral  resources  and  enthusiasm.  He  recognized  it,  and  he  con- 


OF  NERVOUS   DISORDERS         419 

fessed  his  moral  weaknesses,  which  had  on  another  occasion 
brought  him  to  morphinism,  of  which,  however,  he  had  been 
cured. 

We  talked  together  quite  pleasantly  on  hygiene  and  phi- 
losophy, and  when  I  had  finished  the  patient  cried :  "  You 
have  opened  new  horizons  for  me !  Why  has  no  one  told  me 
that  before?  How  is  it  that  I  was  not  able  myself  to  see  these 
truths  ?  Evidently  I  am  in  good  physical  health,  and  I  have  no 
need  of  material  treatment.  I  must  try  my  moral  resources. 
I  believe  that  now  I  can  return  home  and  take  up  my  practise. 
Permit  me,  however,  to  spend  to-morrow  in  your  office;  per- 
haps I  may  have  some  suggestions  to  submit  to  you  or  some 
advice  to  ask." 

He  came  the  next  day,  and,  more  convinced  than  on  the 
evening  before,  returned  home  and  took  up  his  business.  A 
few  weeks  later  he  announced  to  me  that  his  psychic  health 
grew  better  day  by  day.  In  a  single  conversation  he  had 
grasped  the  whole  truth. 

In  returning  to  his  gynecological  practise  he  recognized 
that  amenorrhea,  dysmenorrhea,  and  leucorrhea  might  have 
a  psychic  origin;  he  found  out  the  mental  condition  of  his 
patients  and  was  able  to  put  these  ideas  to  good  use  to  cure 
them. 

In  one  of  his  letters  he  said  to  me :  "  I  can  not  say  that 
I  am  no  longer  neurasthenic,  but  I  comfort  myself  by  the  fact 
that  everybody  around  me  is  also.  When  I  feel  my  courage 
ebbing,  I  read  the  letters  of  Seneca  to  Lucilius ! " 

Since  then  I  have  seen  not  this  patient  but  this  friend 
several  times;  he  has  been  able  to  preserve  the  moral  at- 
titude which  he  found  so  quickly. 

Young  men  who  are  not  yet  blase  subject  themselves  very 
easily  to  the  strengthening  influence  of  encouragement.  A 
law  student  twenty  years  of  age  came  to  consult  me.  He  had 
been  treated  for  several  years  by  a  number  of  doctors  who 
pronounced  him  anemic.  At  last  one  physician,  with  more 
perspicacity,  recognized  the  neurasthenia,  and  the  patient,  sub- 
jecting his  own  case  to  an  intelligent  analysis,  traced  various 


420  PSYCHIC  TREATMENT 

stigmata  of  nervousness  in  his  family.  This  evidence  was 
scarcely  encouraging;  it  gave  rise  to  new  phobias. 

A  man  of  very  exact  habits,  he  had  noted  his  symptoms: 
continual  fatigue,  difficulty  in  working,  failure  of  memory. 
He  felt  pulsations  in  his  head,  slept  badly,  and  had  little  appe- 
tite. However,  his  sleep  was  a  little  better  since  he  had  taken 
a  vacation.  His  eyes  were  often  inflamed  and  he  noticed  that 
they  were  red  when  he  was  nervous.  He  experienced  a  sen- 
sation of  heaviness  in  his  legs  and  had  thought  that  he  ought 
to  ride  from  the  railway  station  to  my  house.  The  previous 
winter  he  had  suffered  from  digestive  troubles  which  had  not 
yielded  to  any  medication. 

His  appetite  really  was  fair  but  he  did  not  dare  to  satisfy 
his  hunger  in  the  evening  for  fear  of  not  sleeping  well.  He 
had  often  had  from  childhood  palpitation  of  the  heart  and  he 
had  himself  recognized  its  emotional  origin;  for  the  expec- 
tation of  the  slightest  event  brought  it  on.  He  had  practised 
onanism  from  fourteen  to  seventeen  years  of  age,  and  he  was 
subject  to  frequent  emissions  which  he  struggled  against;  and, 
finally,  he  alternated  between  constipation  and  outbreaks  of 
diarrhea,  and  he  was  subject  to  angina. 

In  spite  of  these  sufficiently  marked  and  rebellious  symp- 
toms of  neurasthenia,  the  patient  had  preserved  a  young  man's 
mentality;  he  still  saw  things  in  a  rosy  light.  I  profited  im- 
mediately by  this  mentality,  and  I  did  not  hesitate  to  say  to 
him :  "  But,  my  friend,  there  is  nothing  at  all  the  matter  with 
you.  You  are  a  trifle  thin  because  you  have  not  dared  to 
satisfy  your  hunger,  but  you  have  a  good  constitution  and  you 
ought  to  have  the  dominating  quality  of  youth — confidence  in 
yourself.  Above  all,  do  not  become  hypochondriacal !  Why 
do  not  let  yourself  be  disturbed  because  your  heart  beats 
when  you  know  that  it  is  you  yourself  that  brings  it  on  by 
having  emotions  for  nothing  at  all?  A  student  should  not 
have  the  sensitiveness  of  a  young  girl.  As  to  your  feelings 
of  tire,  it  seems  to  me  that  you  submit  to  them  too  passively. 
Shake  yourself  up.  Why,  you  are  young,  strong,  and  healthy ! 
Throw  away  all  these  diseases  that  are  of  no  account  into  the 
waste-basket  for  petty  ailments." 


OF  NERVOUS   DISORDERS         421 

The  conversation  continued  in  this  tone,  and,  leaving  the 
patient  to  take  up  his  normal  life,  I  begged  him  to  return  in 
a  fortnight.  He  did  not  come  back,  but  at  the  end  of  a 
month  he  wrote  to  me :  "  I  am  getting  along  very  well.  Just 
imagine  that  when  I  left  your  house  I  took  a  walk  through 
the  town  for  two  hours  without  any  fatigue.  I  have  gone 
back  to  my  work  and  my  student  life,  which  is  at  the  same 
time  laborious  and  gay." 

Later  he  announced  to  me  that  the  improvement  continued 
and  that  he  had  just  cured  a  cousin  afflicted  with  a  long- 
standing neurasthenia  by  repeating  my  advice  to  him. 

It  is  not  rare  to  find  that  patients  cured  by  this  psycho- 
therapy are  able  in  turn  to  influence  other  subjects,  and  I 
know  one  of  my  clients,  a  Jesuit  Father,  who  has  already 
several  cures  to  his  account. 

The  reader  might  have  the  impression  that  the  cases  which 
I  have  just  quoted  were  not  serious,  that  they  had  to  do  only 
with  slight  neurasthenia.  Why,  then,  were  they  not  cured 
before?  Why  did  the  patients  have  to  go,  without  success,  to 
several  different  physicians? 

I  have  seen  the  same  means  lead  to  cure  in  cases  which 
seemed  hopeless,  and  which,  ten  years  ago,  would  have  seemed 
to  me  to  require  Weir  Mitchell's  cure  in  the  strictest  sense. 

A  few  years  ago  I  received  in  my  office  a  young  man 
twenty  years  of  age  who  was  a  medical  student.  At  the  first 
glance  I  recognized  in  him  major  neurasthenia — fat,  pale,  and 
puffy.  He  came  forward  in  a  slow  and  solemn  manner,  with 
that  tragic  look  which  melancholiacs  often  have.  He  related 
his  symptoms  to  me  as  follows :  *'  I  have  been  ill  for  several 
years.  At  first  I  had  a  diseased  appetite,  a  veritable  craving 
for  food,  and  I  reached  the  weight  of  two  hundred  and  ten 
pounds,  with  a  waist  measure  of  about  sixty-two  inches. 
My  appetite  diminished  little  by  little  and  gave  place  to  abso- 
lute loss  of  appetite  with  dyspepsia.  I  got  so  that  I  could  no 
longer  stand  any  food;  the  slightest  meal  caused  the  feeling 
of  a  most  distressing  weight  in  my  stomach  which  lasted  for 
several  hours.  I  could  no  longer  even  take  milk.  After  each 


422  PSYCHIC  TREATMENT 

meal  I  experienced  very  painful  congestions  which  did  not 
stop  for  several  hours. 

"  I  was  always  constipated ;  often  four  or  five  days  would 
pass  without  my  being  able  to  go  to  the  toilet.  During  the 
summer  of  1896  my  urine  began  to  be  much  affected.  It  was 
milky  and  contained  an  abundance  of  phosphates.  I  was 
greatly  inconvenienced  by  palpitation  of  the  heart,  chiefly  after 
my  meals.  I  had  intermittences ;  the  heart  would  stop  for  the 
period  of  one  or  two  pulsations,  then  it  would  begin  to  beat 
with  an  accelerated  action.  In  the  night  this  arythmia  was 
accompanied  with  pain  and  oppression. 

"  For  a  long  time  I  have  felt  my  intellectual  strength  fail- 
ing. I  have  been  obliged  to  diminish  my  work,  and  in  June 
I  was  no  longer  able  to  stand  the  slightest  intellectual  occu- 
pation. I  could  not  fix  my  attention ;  a  few  moments  of  read- 
ing gave  me  a  feeling  of  congestion ;  a  mist  spread  before  my 
eyes,  the  letters  danced  and  I  could  no  longer  understand  what 
I  was  reading.  I  was  obliged  to  stop  all  correspondence.  I 
experienced  pains  in  the  head,  chiefly  between  the  eyes ;  it 
seemed  to  me  as  tho  my  head  were  held  in  a  vise.  This  ceph- 
alalgia  was  more  marked  in  the  morning  on  awakening  than 
in  the  evening.  It  seemed  to  me  that  I  was  in  a  contiunal 
dream;  I  was  indifferent  to  everything  and  could  not  get  out 
of  my  apathetic  condition. 

"  My  moral  condition  was  very  bad ;  I  was  loaded  down 
with  a  weight  of  discouragement.  Occasionally  this  psychic 
depression  was  interrupted  by  a  few  brief  moments  of  excite- 
ment, but  at  the  end  of  a  few  minutes  I  fell  back  into  my  pros- 
tration. I  had  become  iritable,  and  the  privation  of  a  desired 
object  threw  me  into  a  fit  of  rage,  which  left  me  exhausted  for 
several  hours.  My  physical  strength  had  diminished;  I  was 
afflicted  with  insomnia  and  could  not  go  to  sleep  until  toward 
two  or  three  o'clock  in  the  morning.  I  was  always  too  warm, 
so  much  so  that  in  January  I  used  to  stay  by  the  open  win- 
dow without  heat  in  the  room.  At  night  my  head  grew  heated 
on  my  pillow.  In  summer  my  sleep  came  back  but  it  was 
troubled  by  dreams. 

"  For  a  long  time  I  have  been  losing  my  hair,  so  much  so 


423 

that  I  am  at  the  point  of  becoming  decidedly  bald.  I  was  sub- 
ject to  a  chronic  coryza.  The  slightest  scratch  would  take 
some  time  to  heal,  and  would  be  apt  to  suppurate ;  in  fact,  my 
general  condition  was  very  bad. 

It  is  useless  to  say  that,  either  on  my  own  responsibility 
or  the  advice  of  physicians,  I  have  been  saturated  with  anti- 
pyrin,  bromides,  and  arsenic.  I  have  taken  hydrochloric  acid 
for  my  digestion  and  have  exhausted  the  lists  of  purgatives. 
My  confidence  in  medicine  has  been  completely  shaken." 

After  having  listened  to  this  recital  and  noticed  the  pro- 
found condition  of  melancholy,  I  had  at  first  a  very  unfavor- 
able impression;  but  the  very  fear  of  failure,  and  the  feeling 
of  pressing  danger,  gave  me  back  my  courage. 

Considering  his  obesity  I  did  not  think  the  treatment  in 
bed  should  be  indicated ;  I  had  only  to  put  him  upon  an  extra 
diet  of  milk.  A  treatment  in  the  sanitarium,  which  is  always 
more  or  less  expensive,  seemed  to  me  a  pity  by  reason  of  the 
poverty  of  the  young  man,  who  would  have  had  some  scruples 
about  burdening  his  parents  with  his  expenses. 

After  a  few  seconds'  reflection,  I  decided  upon  my  course, 
and  I  said  to  the  patient :  "  My  friend,  you  can  cure  yourself 
without  severe  measures;  but  you  must  listen  closely  to  me. 
You  are  going  to  go  back  home  to  your  boarding-house,  and 
you  are  going  to  begin  an  almost  normal  life  again.  Eat  your 
three  ordinary  meals  without  making  any  selection  of  your 
food;  I  recommend  especially  green  vegetables.  Do  not  take 
too  much  meat,  and  cut  out  wine. 

"  Suppress  the  constipation  by  training  yourself  to  go  at 
a  regular  hour.  Go  to  bed  toward  ten  o'clock  and  begin  the 
night  without  any  fear  of  insomnia. 

"As  to  work,  do  as  much  as  you  can,  if  only  for  five  min- 
utes, and  when  you  have  a  headache,  or  that  congested  feeling, 
stretch  yourself  out  on  a  sofa  and  take  up  your  work  again 
as  soon  as  you  can.  But,  above  all,  get  rid  of  every  fear  con- 
cerning all  these  functional  troubles.  They  will  disappear  if 
you  know  how  to  neglect  them.  Your  trouble  is  more  moral 
than  physical,  and  little  by  little  you  will  recover  your  health 
and  your  ability  to  work.  Come  back  in  a  fortnight." 


424  PSYCHIC  TREATMENT 

The  patient  came  back.  He  walked  with  a  quicker  step, 
and  a  smile  lit  up  his  face,  which  was  still  puffy.  "  I  thought 
that  that  would  work,"  said  he. 

In  this  second  consultation  I  went  over  these  counsels  in 
detail,  laying  before  my  intelligent  patient  all  my  views  on  the 
influence  of  the  moral  over  the  physical.  A  fortnight  later  I 
saw  him  again  for  the  third  and  last  time.  He  had  grown 
thinner,  his  figure  was  younger,  and  he  had  the  elastic  step 
of  a  young  man.  "  It  works !  "  he  cried,  gaily.  "  I  can  al- 
ready work  several  hours  a  day;  I  have  a  normal  appetite; 
I  no  longer  suffer  from  my  stomach ;  I  have  regular  passages ; 
I  sleep,  and  my  headaches  are  very  rare." 

A  few  months  later  I  saw  my  young  man  upon  a  bicycle 
pedaling  with  energy.  I  learned  that  he  was  able  to  take  up 
very  serious  studies  as  well  as  worldly  distractions  and  sports. 
He  passed  excellent  examinations.  In  1897  he  stood  the  mili- 
tary service  without  difficulty.  From  that  time  his  health  has 
been  perfect. 

Here  is  a  patient  whom  I  have  seen  three  times,  to  whom  I 
have  only  given  counsels  of  physical  and  moral  hygiene  with- 
out isolation.  His  improvement  began  with  the  first  consul- 
tation, and  he  advanced  gradually  but  so  quickly  that  he  had  no 
need  to  come  to  me  for  a  fourth  consultation.  Once  started 
upon  the  right  way  he  progressed  alone  toward  his  cure. 

The  patient,  who  summed  up  his  observations  in  writing, 
had  completely  grasped  the  value  of  moral  treatment.  "After 
that  consultation,"  he  wrote,  "  I  felt  myself  already  morally 
better,  and  consequently  physically  also.  We  had  some  other 
similar  conversations  which  had  the  effect  of  building  up  my 
courage  and  of  giving  me  back  my  energy  which  had  left  me 
for  a  long  time.  A  month  later  I  could  take  up  my  studies 
progressively,  working  only  a  little,  but  enough  to  chase  away 
the  phantom  of  my  ills,  which  until  then  had  constantly  haunt- 
ed my  mind." 

Here  is  a  young  physician  who  remained  convinced  of  the 
influence  of  the  moral  over  the  physical,  and  who,  I  hope,  will 
profit  by  this  personal  experience  to  bring  many  neurasthenics 
back  to  a  healthy  life. 


OF  NERVOUS   DISORDERS         425 


CHAPTER   XXXIII 

Piychotherapeutic  Treatment  Without  the  Intervention  of  Physical  Meas- 
ures—Case  of  Neurasthenia  of  a  Melancholic  Nature  —  Cure  and 
Relapses  —  Case  of  Disequilibrium  —  Suppression  of  all  Maniacal 
Impulsions  by  a  Few  Conversations — Incurability  of  Certain  Psy- 
choneuroses — Mental  Peculiarities  which  Make  One  Foresee  Failure 
— Moral  Idiots — Disturbances  of  Feelings  of  Affection  in  the  Psycho- 
neuroses 

THE  same  measures  may  lead  to  cure  (I  would  not  have 
dared  to  hope  for  it  in  other  days)  in  cases  where  the  trouble 
is  still  older.  The  following  case  greatly  astonished  dis- 
tinguished neurologists  and  psychologists  who  had  been  at- 
tending the  patient  for  a  number  of  years. 

Mme.  W is  a  strong  woman  thirty-five  years  of  age 

who,  for  about  sixteen  years,  suffered  from  a  neurasthenic 
condition  that  was  melancholic  in  its  nature,  to  which  peri- 
odically there  were  added  some  hysterical  symptoms.  No 
treatment  in  this  long  period  had  been  able  to  bring  about  a 
cure;  periods  of  improvement  were  only  slight  and  transient. 
Already  impressionable  and  easily  tired  when  a  young  girl, 
the  patient  had  suffered  from  a  slight  catarrh  of  the  ear.  The 
deafness  which  resulted  from  it  had  rendered  social  duties 
arduous  to  her  and  had  contributed  to  the  encouragement  of  a 
melancholy  disposition.  She  had  always  been  somewhat  lack- 
ing in  decision  and  had  a  tendency  to  take  things  tragically. 

Her  hereditary  antecedents  were  not  unfavorable.  Her 
mother,  somewhat  nervous,  had  brought  up  her  child  with 
more  love  than  good  sense;  she  had  never  fully  understood 
her  daughter's  need  of  rest  and  had  often  opposed  measures 
which  would  have  been  useful.  A  brother  had  been  neuras- 
thenic but  had  recovered  his  psychic  equilibrium  as  a  result 
of  making  a  favorable  change  in  his  career.  The  other  mem- 


426  PSYCHIC  TREATMENT 

bers  of  the  family  seem  to  have  been  exempt  from  nervous 
defects. 

The  patient  was  married  at  twenty-seven  years  of  age 
under  excellent  moral  conditions  and  there  was  always  perfect 
conjugal  harmony  in  the  household.  At  twenty-eight  years 
she  had  a  rather  difficult  confinement.  After  that  came  in- 
creasing fatigue,  inability  to  stand  reading  or  any  mental  work, 
and  headaches.  The  neurasthenic  casque,  the  sensation  of 
clutching  on  the  top  of  the  head,  and  sadness — all  these  char- 
acteristic symptoms  of  neurasthenia  existed  alongside  of  a 
perfect  state  of  bodily  health,  a  rose-tinted  complexion,  and  a 
normal  state  of  nutrition.  A  sojourn  in  the  mountains  brought 
only  slight  relief. 

In  the  third  year  of  her  marriage  a  second  pregnancy  took 
place  which  had  no  influence  upon  the  disease.  Hydrothera- 
peutic  treatment  and  massage  were  tried  without  the  slightest 
success.  A  second  course  of  treatment  of  the  same  kind  un- 
dertaken in  the  following  year  brought  about,  on  the  con- 
trary, marked  aggravation,  even  in  the  hands  of  a  celebrated 
doctor  in  whom,  however,  the  patient  did  not  have  any  con- 
fidence. 

The  condition  grew  worse  and  worse.  Physical  and  intel- 
lectual helplessness,  sadness,  intense  precordial  anguish,  and 
frequent  insomnia  marked  its  progress.  They  tried  to  combat 
the  symptoms,  which  were  already  melancholic,  by  rest  in  bed 
for  several  weeks,  and  bromide  of  potassium,  the  use  of  which 
was  prolonged  during  six  months. 

During  two  years  treatment  by  physical  agents  was  per- 
sisted in,  and  the  disease  continually  grew  worse.  The  pre- 
cordial anguish  became  one  of  the  predominant  symptoms. 
The  patient  became  irritable  and  could  not  bear  the  presence 
of  her  children.  The  characteristic  symptom  of  such  melan- 
cholic conditions,  the  conviction  of  incurability,  was  estab- 
lished. The  physician  who  cared  for  her  during  the  last  two 
years  did  not  dare  to  state  that  it  was  hysteria,  altho  the  sen- 
sation of  "  clutching  on  the  head  "  seemed  to  recall  to  him 
the  "clou  hysterique."  He  found  nothing  abnormal  in  her 
sexual  life,  and,  inclined  to  attribute  an  important  role  to  this 


OF  NERVOUS   DISORDERS         427 

etiological  fact,  he  still  hesitated  in  his  diagnosis.  Having 
determined  a  slight  uric  and  oxaluric  diathesis,  he  wondered 
whether  this  psychopathic  state  might  not  be  due  to  autoin- 
toxication. He  noted,  as  aggravating  circumstances,  the  deaf- 
ness and  the  buzzing  in  the  ears,  which  weakened  the  patient 
and  encouraged  her  pessimistic  disposition. 

At  the  first  interview  I  was  struck  by  the  excellent  health 
of  the  patient,  and  the  more  I  questioned  her  the  more  I  saw 
the  predominant  disturbance  of  the  mental  condition  in  the 
hypochondriacal  and  melancholic  sense.  It  was  with  fright 
that  she  acknowledged  her  nervous  troubles  and  that  she 
stated  her  helplessness  in  every  domain.  She  was  of  the  con- 
viction that  she  could  not  be  cured  and  she  showed  but  very 
slight  confidence  in  my  treatment.  This  confidence  diminished 
still  further  when  I  confided  to  her  my  intention  of  making  her 
undergo  a  purely  moral  treatment. 

In  spite  of  the  depressed  condition  of  the  patient,  her  slow 
step,  and  the  anxious  look  of  her  face,  I  renounced  at  the  start 
the  rest  cure  in  bed.  Overfeeding  was  in  no  wise  indicated, 
the  patient  having  a  tendency  to  obesity  and  plethora.  I  iso- 
lated her  in  a  boarding-house  in  the  country,  in  order  to  avoid 
any  meddling  on  the  part  of  her  husband  in  the  treatment. 
I  did  not  then  know  all  the  virtues  of  that  excellent  man. 
However,  detained  by  his  business,  he  could  not  settle  himself 
near  his  wife. 

The  entire  treatment  was  unique  from  the  psychotherapic 
point  of  view.  I  allowed  the  patient  to  live  just  as  she  wanted 
to.  She  could  get  up  or  stay  in  bed,  she  could  remain  alone 
in  her  room  or  enter  into  conversation  with  the  other  boarders, 
and  follow  all  the  passing  impulses  of  her  disposition.  Ac- 
companied by  a  chambermaid,  she  could  take  short  walks  or 
remain  quiet,  read  or  do  needlework.  I  intentionally  did  not 
try  to  inform  myself  concerning  these  details  which  in  my 
opinion  were  of  no  importance.  She  had  the  same  liberty  in 
regard  to  her  food. 

In  our  daily  conversations,  without  letting  myself  be  dis- 
couraged by  the  skepticism  of  the  patient,  I  insisted  that  she 
should  treat  all  her  nervous  troubles  as  tho  they  were  trifling 


428  PSYCHIC   TREATMENT 

ailments,  particularly  the  bands  about  the  head,  the  neuras- 
thenic aches,  the  sensations  of  heat  and  cold,  insomnia,  and 
anguish.  I  showed  her  that  these  were  mere  trifling  conse- 
quences of  nervousness,  and  that,  no  matter  how  distressing 
they  might  be,  they  were  always  without  danger.  After  a  few 
days  the  patient  gave  up  all  complaints  on  the  subject. 

The  ground  was  cleared.  The  most  tenacious  phobia  was 
that  of  precordial  anguish.  This  mental  trouble  disturbed  her 
and  made  her  fear  insanity.  While  always  recognizing  that 
the  feeling  might  be  most  distressing  for  her,  and  always  sym- 
pathizing with  her,  I  kept  saying  to  her  that  from  the  medical 
point  of  view  this  trouble  was  no  more  disturbing  than  the 
others.  From  day  to  day  I  saw  the  moral  ascendency  which 
she  exercised  over  herself  continually  increasing.  Her  pro- 
testations took  the  character  of  specious  objections  which  she 
would  submit  to  me  with  a  smile,  saying :  "  I  quibble  over 
this,  but  I  feel  that  you  are  right !  " 

Little  by  little,  leaving  all  manifestations  of  nervousness 
out  of  the  question,  I  dared  to  approach  the  more  general 
questions  of  morality  and  of  practical  philosophy.  I  did  not 
hesitate  to  put  my  finger  on  the  diseased  egoism  of  her  life, 
in  that  she  was  always  preoccupied  with  her  own  well-being. 
I  changed  the  basis  of  her  thoughts  in  the  altruistic  sense, 
advising  her  to  think  of  those  who  belonged  to  her,  her  ex- 
cellent husband,  and  her  children.  She  became  enthusiastic 
over  these  very  simple  lessons  upon  the  art  of  living,  and 
drew  me  out  by  her  questions  on  subjects  which  were  always 
more  elevated.  Sometimes  she  considered  my  counsels  too 
theoretical  and  wanted  me  to  put  them  more  concretely ;  often, 
also,  as  like  the  majority  of  neurotics,  she  seemed  to  admit 
that  all  that  I  had  said  might  be  true  for  others,  but  for  her- 
self she  suffered  from  weakness  of  nerves.  Nothing  is  so 
easy  for  one  who  has  seized  the  indications  of  psychotherapy 
as  to  combat  these  objections  by  a  prudent  dialog  and  by 
moral  influence. 

Little  by  little  the  inner  conversion  was  complete,  and  I 
could  advise  correspondence  with  her  husband.  Two  months 
was  enough  to  bring  about  the  cure,  when  the  patient  could 


OF  NERVOUS   DISORDERS         429 

take  her  place  in  her  household,  active,  indefatigable,  gay,  and 
free  from  all  phobias. 

The  distinguished  physician  who  had  had  her  under  his 
care  saw  her  several  weeks  after  her  return,  and  wrote  to  me: 
"  I  have  seen  your  patient  and  I  must  admit  that  she  is  simply 
'  another  person  '  from  the  one  whom  I  watched  for  two  years. 
I  do  not  think  that  one  can  attribute  such  a  change  to  two 
months'  sojourn  in  the  country,  and  to  comparative  isolation. 
It  is  perfectly  evident  that  the  '  causa  efficiens '  lies  in  your 
moral  treatment." 

For  ten  months  the  cure  held  good,  and  I  would  have  be- 
lieved the  patient  free  from  all  possibility  of  relapse,  but  soon 
I  received  alarming  letters.  The  patient  was  tired,  had  had 
too  much  care,  and,  at  the  time  when  she  needed  to  have  all 
her  activity,  she  hurt  the  arch  of  her  foot  in  walking.  It  was 
only  a  little  red  spot  brought  on  by  the  pressure  of  her  shoe, 
but  it  was  the  occasion  of  a  relapse,  and  it  is  interesting  to  see 
by  what  mechanism  this  back-sliding  was  accomplished  and 
how  even  the  physicians  contributed  to  give  rise  to  it.  First, 
without  sufficiently  insisting  upon  the  slight  importance  of  the 
lesion,  they  had  the  patient  have  special  shoes  made  to  avoid 
any  pressure  upon  the  painful  place;  then  they  advised  rest 
on  the  sofa,  and  one  doctor  thought  he  perceived  some  traces 
of  phlebitis.  Instead  of  assuring  himself  of  it  and  of  saying 
nothing  about  it  afterward,  he  set  forth  his  hypothesis  before 
the  patient.  Thus  our  disconsolate  patient  was  again  reduced 
to  helplessness  at  the  very  time  when  she  had  a  great  task 
before  her. 

For  several  weeks  she  tormented  herself  in  this  wise.  She 
lost  sleep  over  it  and  her  nervousness  increased.  The  idea 
that  possessed  her  was  her  increasing  incapacity,  giving  rise 
within  her  to  the  fear  that  she  would  not  have  sufficient 
strength  to  take  her  place  as  the  mother  of  her  family.  She 
heaped  herself  with  reproaches;  her  preoccupations  became 
distinctly  melancholy,  and  were  accompanied  by  true  precor- 
dial  anguish  and  insomnia. 

The  patient  came  to  see  me,  and  from  the  first  interview 


430  PSYCHIC  TREATMENT 

she  showed  the  conviction  that  she  was  much  worse  than  she 
was  the  first  time,  and  that  she  would  never  be  well  again. 

In  the  first  conversation,  I  immediately  dissipated  all  fear 
on  the  subject  of  her  foot.  After  having  examined  her  care- 
fully, I  was  able  to  exclude  all  phlebitis;  the  whole  thing  re- 
duced itself  to  a  slight  irritation  of  the  skin.  I  showed  her 
that  this  trouble  was  so  insignificant  she  need  take  no  pre- 
caution on  the  subject  of  her  footgear.  A  smile  came  to  the 
lips  of  the  patient.  I  dared  adopt  a  tone  of  pleasantry,  and  I 
told  her  that  I  was  very  glad  to  take  care  of  her — all  except 
her  foot,  which  she  must  never  mention  to  me  again!  She 
accepted  this,  put  on  any  shoes  whatsoever  and  never  spoke 
to  me  afterward  about  her  foot.  As  in  the  first  treatment  we 
conversed  on  psychotherapy  and  moral  philosophy,  and  at  the 
end  of  six  weeks  the  patient  was  cured. 

She  spent  thirteen  months  in  a  state  of  perfect  comfort. 
She  underwent  another  pregnancy;  she  nursed  her  sick  chil- 
dren with  devotion  in  the  face  of  the  greatest  difficulties.  It 
was  not  only  a  question  of  improvement,  it  was  a  complete 
suppression  of  all  her  troubles.  She  felt  herself  even  better 
than  during  the  sixteen  months  previous.  But  we  were  not 
yet  at  the  end  of  our  troubles. 

As  a  result  of  the  transfer  of  her  husband's  business,  she 
was  obliged  to  settle  in  another  town,  where  she  found  herself 
confronted  by  new  difficulties  following  a  period  of  overstrain. 
She  exaggerated  them  and  experienced  anew  the  feeling  that 
she  was  unequal  to  her  task.  Always  timorous  and  undecided, 
she  relapsed  into  the  same  neurasthenic  and  melancholic  con- 
dition. 

This  periodicity  in  her  relapses  might  make  one  class  her 
in  the  periodic  depression  category  of  Lange.  Perhaps  some 
minute  inner  change  of  the  chemistry  of  the  organism  caused 
the  patient's  impressionability.  At  the  same  time  each  of  her 
back-slidings  had  been  brought  on  by  real  difficulties,  capable 
in  themselves  of  discouraging  one,  and  as  she  was  not  suffi- 
ciently established  in  her  morale,  she  did  not  know  how  to 
combat  them  with  genuine  optimism. 

It  was  not  that  she  had  forgotten  my  counsels.     On  the 


OF  NERVOUS   DISORDERS         431 

contrary,  she  used  them  and  struggled  on  for  several  months. 
Sometimes  she  got  hold  of  herself,  and  then  she  fell  back. 
Good  reports  alternated  with  bad  in  letters  and  telegrams. 
I  had  the  feeling  that  if  I  had  been  near  her  I  could  have  suc- 
ceeded in  upholding  her  and  assuring  her  of  victory. 

I  tried  by  letters  to  give  her  courage,  hoping  to  be  upheld 
by  the  family  physician,  who  possessed  the  patient's  confi- 
dence. But  my  confrere  did  not  have  faith.  He  considered 
the  patient's  condition  too  serious  and  showed  from  the  first 
the  idea  that  she  could  not  be  cured  unless  she  would  put 
herself  in  my  hands.  So  I  found  myself  obliged  to  take  her 
for  the  third  time. 

Even  more  than  the  preceding  year  she  seemed  persuaded 
that  she  could  not  be  cured.  I  stated,  on  the  contrary,  that 
the  attack  would  be  much  shorter  and  I  mitigated  still  more 
the  conditions  of  treatment.  I  placed  her  in  a  boarding-house 
which  was  a  less  quiet  environment.  Her  husband  stayed  with 
her  there  for  some  time.  I  sanctioned  such  worldly  distrac- 
tions as  concerts  and  the  theater. 

Our  conversations  no  longer  had  nervous  diseases  as  their 
subject.  I  neglected  them  intentionally  and  the  patient  seemed 
to  forget  them  also.  At  the  end  of  a  few  days  her  hopes  re- 
vived and  the  patient  took  delight  in  conversations  which  were 
always  more  and  more  elevated.  She  would  set  forth  certain 
conceptions  of  life  which  she  asked  me  to  elucidate.  She  was 
a  religious  soul  but  not  bigoted.  She  sought  help  from  moral 
writers,  whether  they  were  believers  or  freethinkers.  She 
knew  how  to  reason  without  giving  up  her  faith.  At  the  end 
of  a  few  weeks  she  was  absolutely  cured.  A  year  passed  in 
this  way.  Then,  as  after  the  second  treatment,  she  again  be- 
came pregnant,  but  she  was  in  no  way  disturbed  in  her  health 
by  it.  Her  moral  attitude  is  now  much  stronger  than  for- 
merly. Her  convictions  are  firmer  and  the  brave  letters  which 
she  addresses  to  me  seem  to  augur  well  for  the  future. 

Let  me  cite  still  one  last  case,  which,  altho  the  cure  is  not 
yet  complete,  shows  that  in  this  treatment  by  psychotherapy 
persuasive  influence  is  everything. 

M.  P is  a  young  man  twenty-five  years  of  age,  of 


432  PSYCHIC   TREATMENT 

exceptional  intelligence  and  cultivation,  who,  in  the  commer- 
cial career  which  he  has  taken  up,  has  shown  remarkable 
aptitude.  Too  tall,  thin,  and  pale,  he  shows  some  symptoms 
of  physical  debility,  but  from  the  point  of  view  of  intelligence 
seems  particularly  well  endowed.  Toward  his  nineteenth  year, 
following  an  attack  of  diphtheria,  he  fell  into  a  neurasthenic 
state.  He  was  sent  to  college,  the  name  of  which  he  would 
not  tell  me — that  was  one  of  his  phobias — and  without  stating 
precisely  how,  he  said  he  felt  unhappy  in  every  respect.  For 
three  years  this  distressing  memory  remained  with  him  as 
an  obsession,  and  brought  on  a  continual  condition  of  neuras- 
thenia, which,  however,  was  not  as  yet  severe.  In  the  course 
of  his  military  service  he  had  a  serious  attack  of  pneumonia. 
His  nervous  condition  grew  worse,  and  the  exhaustion,  mental 
depression,  and  melancholic  ideas  lasted  about  two  months. 

In  1901  he  threw  himself  into  commercial  affairs.  He 
departed  for  America,  where  he  remained  a  year  and  tired 
himself  greatly.  Even  while  away  from  his  own  country, 
when  he  thought  of  the  college  where  he  had  suffered  he  ex- 
perienced a  distressing  feeling  which  obliged  him  to  make 
involuntary  movements.  On  his  return  to  Europe  the  meet- 
ing of  old  friends  rendered  the  obsession  more  acute,  and, 
moved  by  strange  associations  of  ideas,  he  felt  impelled  to 
make  a  movement  and  to  repeat  it  as  many  as  thirty  times. 
These  obsessions  finally  began  to  disturb  all  the  actions  of  his 
life.  He  could  neither  dress  nor  undress  himself  alone  on 
account  of  the  feeling  of  being  obliged  to  make  the  same 
movement  over  and  over.  He  could  not  shave  himself,  and 
he  let  his  beard  grow  long.  He  would  keep  coins  in  his  hand, 
not  daring  to  put  them  into  his  purse.  Without  his  being 
able  to  explain  clearly  why,  everything  gave  rise  to  the  obses- 
sing idea.  He  did  not  dare  to  touch  the  handles  of  doors  and 
he  was  continually  washing  his  hands. 

He  had  undergone  various  treatments  without  success. 
New  tics  were  constantly  occurring.  When  he  was  taking 
a  walk  he  would  have  to  turn  around  and  go  back  the  same 
way,  or  he  could  only  go  ahead  by  kicking  a  pebble  before  him. 

At  the  time  when  I  saw  the  patient,  in  August,  1903,  I 


OF  NERVOUS   DISORDERS         433 

did  not  dare  to  take  him  for  treatment.  I  thought  that  a 
condition  of  such  nature  could  only  yield  after  extended  treat- 
ment, and  my  sanitarium  could  not  accommodate  patients  that 
had  to  stay  for  such  a  long  time.  I  sent  him  to  an  excellent 
confrere  who  was  both  a  physician  and  an  alienist.  He  of- 
fered him  hospitality  in  his  family.  The  young  patient  found 
in  these  sympathetic  surroundings  all  that  he  could  desire  from 
the  moral  as  well  as  physical  standpoint.  He  had  nothing 
but  praise  for  the  care  he  received.  He  grew  stronger  and 
could  enjoy  life  in  the  open  air,  but  his  manias  and  his  ob- 
sessions persisted,  and  at  the  end  of  four  months  his  uneasy 
relatives  begged  me  to  see  the  patient  again. 

He  came  accompanied  by  his  physician  who  had  grown  to 
be  his  friend  and  we  had  a  very  long  conversation.  I  besought 
the  patient  to  give  up  struggling  against  each  of  his  obsessions 
and  manias,  showing  him  that  he  only  made  them  spring  up 
again.  "  When  a  brook  has  burst  its  dike,"  I  said  to  him, 
"  you  should  not  try  to  stop  every  one  of  the  rivulets  that 
are  formed;  that  would  be  a  waste  of  time.  You  must  go 
higher  up  and  repair  the  dike  at  the  breach.  You  must  have 
confidence  in  yourself;  you  are  intelligent  and  well  educated, 
and  you  have  a  critical  spirit.  Look  on  and  smile  at  these 
strange  mental  impulsions  but  do  not  try  to  suppress  them  by 
an  act  of  will.  Are  you  not  a  little  superstitions  ?  " 

"  I  really  think  that  he  is,"  responded  his  physician.  "  Just 
imagine,  he  would  not  have  been  willing  to  mount  my  horse 
if  I  had  bought  him  on  a  Tuesday !  " 

"  There  you  are,  my  dear  sir,"  said  I,  "  there  is  only  a  step 
between  superstition  and  obsessions.  In  the  two  cases  the 
association  of  ideas  is  false,  and,  in  spite  of  your  high  intelli- 
gence, you  have  at  bottom  a  certain  lack  of  logic.  Think  a 
little  more  justly  on  these  subjects.  That  will  be  the  best 
way  of  fighting  your  manias." 

This  conversation  of  about  an  hour  and  a  half  comforted 
the  patient;  he  seemed  intensely  interested  and  was  struck  by 
the  logic  of  my  deductions,  but  no  change  took  place  in  him. 

Eight  days  afterward  we  had  another  psychotherapic  se- 
ance. The  conversation  became  more  intimate  and  more 


434  PSYCHIC  TREATMENT 

friendly.  We  came  back  to  these  points  that  were  already 
touched  upon,  putting  the  principal  ideas  more  sharply.  We 
scarcely  spoke  of  manias  and  obsessions.  At  the  third  inter- 
view, eight  days  later,  the  conversation  was  upon  a  still  higher 
plane;  we  talked  philosophy  and  morality.  A  third  person 
would  scarcely  have  suspected  that  it  was  a  medical  consul- 
tation. We  continued  the  conversation  into  the  street.  I 
showed  the  patient  that  it  was  not  necessary  to  drag  the  can- 
non-ball of  memory  after  him  all  his  life. 

He  thanked  me  heartily  for  this  advice,  as  if  it  were  a  great 
moral  discovery  for  him.  I  found  later  that  he  was  suffering 
from  obsessions  of  remorse,  concerning  some  comparatively 
insignificant  events  of  his  past  life;  that  is  why  this  idea  of 
forgetting  the  past  had  struck  him  particularly. 

This  third  conversation  completed  the  work  of  the  two 
others  and  the  patient  from  that  day  on  lost  all  his  manias. 
He  could,  thereafter,  dress  himself  alone,  shave  himself,  and 
suppress  his  impulsive  movements. 

He  is  not  yet  cured;  he  still  has  a  feeling  of  unnecessary 
remorse,  and  is  still  hampered  by  secret  inhibitions,  and  his 
association  of  ideas  is  not  always  correct.  But,  on  the  other 
hand,  it  is  a  fact  that  these  three  conversations  have  made  the 
majority  of  his  symptoms  disappear,  after  a  sojourn  of  four 
months  in  the  home  of  a  physician  who  was  among  the  best 
qualified  to  care  for  such  diseases  had  not  produced  the  slight- 
est definite  result. 

Nevertheless,  during  his  stay  there,  the  physician  had  no- 
ticed the  favorable  influence  of  a  change  of  mental  condition 
as  shown  in  the  patient's  confidence  in  himself.  If  he  were 
called  upon  to  take  some  slight  responsibility,  such  as  to  take 
the  doctor's  children  skating,  or  to  serve  as  a  guide  to  some 
one  along  the  mountain  road,  this  would  be  enough  to  dissi- 
pate the  inhibitions  which  in  other  circumstances  had  hindered 
him.  This  was  because  at  such  times  something  was  depend- 
ing on  him.  In  giving  him  responsibility,  trust  had  been 
shown  in  him,  and  he  felt  obliged  to  justify  it.  The  mere  fact 
of  his  having  sufficient  confidence  in  himself  to  accept  the 
responsibility  was  enough  to  make  him  forget  his  phobias. 


OF  NERVOUS   DISORDERS         435 

But  this  effect  was  only  temporary  and  in  the  main  his  con- 
dition remained  stationary. 

How  can  one  account  for  such  comparative  lack  of  success 
attending  a  comparatively  long  treatment  of  five  months,  made 
by  a  conscientious  alienist?  Why  such  magic  results  after 
three  psychotherapic  conversations?  Well,  as  I  have  said, 
it  is  because  we  have  not  sufficiently  seen  what  can  be  done 
through  the  treatment  of  the  mind  by  means  of  conversational 
methods.  We  count  too  much  on  rest,  good  nourishment,  and 
the  open  air,  and  we  do  not  depend  enough  on  psychotherapy. 
We  forget  Pinel's  counsel  to  try  to  awaken  logical  reflection 
in  the  patient  even  when  he  is  insane.  In  order  to  succeed  in 
these  cases,  the  physician  must  have  an  imperturbable  confi- 
dence in  the  powers  of  logic;  he  must  know  how  to  vary  his 
arguments,  to  reply,  point  by  point,  to  every  objection;  he 
must  know  how  to  bring  his  patient  to  the  point  of  capitula- 
tion and  to  pursue  him  to  his  furthest  entrenchments. 

Can  one  say  that  one  will  always  succeed,  that  all  these 
nervous  patients  will  be  cured  ?  Alas !  no.  There  are  many 
unbalanced  individuals  who  have  no  logic  in  their  heads.  In 
a  sensible  conversation,  whose  end  has  been  to  encourage  them, 
they  only  notice  a  few  catch  phrases,  which  they  interpret 
pessimistically.  They  are  only  looking  for  fresh  reasons  to  dis- 
courage themselves.  There  are  some  whose  capital  of  energy 
is  absolutely  insufficient  and  who  remain  the  subject  of  their 
caprices,  even  tho  they  have  understood  and  they  have  no  ob- 
jections to  offer. 

I  have  seen  those  whose  pessisism  is  such  that  it  persists 
for  years,  altho  they  live  in  conditions  in  which  they  ought  to 
be  happy.  A  lady  who  recognized  the  fact  that  she  had  been 
unhappy  for  twenty-five  years  solely  on  account  of  her  state 
of  mind,  said  to  me :  "  What  can  you  expect  ?  I  am  badly 
built  morally !  " — which  was  true.  There  was  a  native  mental 
deformity  in  her  case.  But  the  mere  recognition  of  her  faults 
was  equivalent  to  an  appreciation  of  the  necessity  of  correcting 
them,  and  this  patient  made  good  progress. 

Such  a  return  to  optimism  is  difficult  among  patients  whose 
life  is  really  troubled — in  young  girls  who  have  had  to  give  up 


436  PSYCHIC   TREATMENT 

marriage  and  who  have  not  known  how  to  take  up  any  especial 
interest  in  life;  in  married  people  who  are  uncongenial  and 
who  are  obliged  to  endure  one  another  as  long  as  they  live; 
in  men  who  through  their  own  fault  or  that  of  others  have 
not  succeeded  in  their  career. 

I  have  been  often  tempted  to  throw  the  handle  after  the 
hatchet  on  recognizing  these  unfavorable  situations.  It  seemed 
cruel  to  demand  that  such  afflicted  persons  should  adopt 
a  stoic  attitude  in  the  presence  of  sufferings  before  which 
I  would  have  myself  recoiled.  But  these  are  the  very  patients 
who  have  brought  me  the  most  courage  and  perseverance. 
They  have  very  quickly  been  able  to  grasp  the  teachings  of 
rational  morality  and  to  adapt  themselves  to  life  as  they  found 
it.  Many  learn  to  make  themselves  content  by  this  rationalism 
and  gain  remarkable  courage;  others  mingle  this  philosophy 
with  the  religion  which  has  been  taught  them.  I  have  not 
noticed  that  these  latter  have  succeeded  any  better  than  the 
others. 

Such  intellectual  intercourse  with  these  patients  has  given 
me  a  much  higher  idea  of  human  mentality.  I  have  found, 
even  in  those  who  were  mentally  weak,  an  unexpected  strength 
of  resistance.  As  long  as  one  finds  a  certain  logic  and  moral 
aspirations,  with  a  tendency  to  perfect  the  moral  ego,  one  need 
not  despair  of  such  patients. 

Unfortunately  there  are  a  great  many  unbalanced  people 
in  whom  the  defects  are  chiefly  moral,  the  moral  sense  being 
absolutely  lacking  in  them.  One  sees  young  men,  intelligent 
for  the  most  part,  incapable  of  carrying  on  their  studies  well, 
or  even  interesting  themselves  in  discussions  of  philosophical 
problems,  in  whom,  moreover,  one  finds  a  total  absence  of 
altruistic  feelings.  They  have  the  same  nature  as  that  of 
criminals.  They  are  as  incurable  as  those  in  whom  a  lack  of 
morality  is  accompanied  by  intellectual  weakness  and  who 
present  stigmata  of  degeneration. 

The  physician  can  not  do  anything  for  these  moral  fools 
whose  conduct  creates  the  most  tragic  situations.  Unfortu- 
nately the  integrity  of  intellectual  faculties  hinders  the  public 
from  recognizing  their  madness.  These  patients  are  quite 


OF  NERVOUS   DISORDERS          437 

able  to  defend  themselves,  and  to  explain  their  aversion  to 
their  neighbors  in  a  plausible  fashion.  It  is  often  impossible 
to  confine  them  in  an  asylum,  and  when  one  succeeds  they 
soon  come  out,  more  ill-natured  than  ever,  and  resume  their 
struggle  with  their  family  with  the  same  cruel  coldness. 

This  pathological  lack  of  morality  is  generally  easily  rec- 
ognizable, but  in  the  presence  of  such  a  serious  disease  one 
should  beware  of  hasty  judgment.  In  a  personal  conversa- 
tion one  can  sometimes  touch  a  sensitive  chord,  a  sentiment 
of  honor,  an  altruistic  idea,  and  moral  orthopedia  is  then 
possible. 

The  prognosis  immediately  becomes  more  favorable  when 
the  examination  of  the  past  shows  that  the  disturbance  of  the 
feelings  is  acquired,  that  it  is  only  the  symptom  of  a  transient 
condition  of  depression. 

There  are  some  forms  of  neurasthenia,  or,  if  you  will,  of 
lack  of  balance,  which  destroy  in  patients  the  affections  which 
they  had  for  their  own  people,  changing  them  into  aversion, 
without  their  being  able  to  describe  the  motives  which  have 
led  to  this  mental  state.  This  symptom  disappears  with  the 
other  manifestation  of  the  psychopathic  condition. 

A  young  man  twenty-seven  years  of  age,  who  seemed 
well  gifted  physically,  intellectually,  and  morally,  overworked 
himself  slightly  at  the  Lyceum.  He  was  taken  with  head- 
aches and  insomnia;  the  slightest  work  brought  confusion  of 
ideas  and  his  studies  had  to  be  interrupted. 

I  put  the  young  patient  upon  Weir  Mitchell's  treatment. 
His  condition  seemed  to  me  from  the  first  very  discouraging, 
for  the  patient  seemed  to  have  a  mentality  that  was  slightly 
puerile  and  fatuous  beyond  all  limits.  He  wrote  out  his 
thoughts  upon  life  and  love  in  a  rhapsodical  style.  These 
extravaganzas  made  me  fear  the  development  of  dementia 
praecox. 

From  the  start  the  patient  declared  to  me  that  he  had 
experienced  a  profound  aversion  to  his  mother  and  sister, 
and  when  I  asked  him  what  he  had  against  them,  he  replied 
calmly  to  me :  "  Nothing ;  my  mother  and  my  sister  have 


438  PSYCHIC   TREATMENT 

always  been  delightful  to  me.  But  what  difference  does  that 
make  ?  I  hate  them !  " 

His  sleep  gradually  became  better,  his  headaches  disap- 
peared, his  thought  became  more  sound,  and  soon  my  patient 
was  able  to  say  to  me :  "  Now  I  no  longer  feel  an  aversion 
to  my  people.  I  only  feel  indifferent."  At  the  end  of  two 
months  the  young  man  had  recovered  his  moral  sentiments 
along  with  his  intellectual  faculties,  and  did  not  cease  to  show 
his  family  the  most  delicate  attention. 

Another  one  of  my  patients  who  was  engaged  to  be  married 
assured  me  he  had  no  reason  to  recall  the  decision  which 
he  had  made,  that  nothing  had  happened  to  cause  a  change 
in  his  feelings.  Nevertheless,  by  some  change  which  had  taken 
place  in  him  his  love  had  almost  changed  to  hate.  The  touch 
of  his  fiancee's  hand  stirred  up  a  feeling  of  repulsion  as  if  he 
had  touched  a  serpent !  The  patient  was  cured  in  two  months' 
time  and  married  his  fiancee.  They  are  happy  and  have  had 
many  children. 

Alienists  recognize  clearly  this  profound  change  of  senti- 
ment which  often  results  in  crime.  But  they  are  not  so  fa- 
miliar with  the  fact  that  one  may  observe  this  pathological 
mentality  in  conditions  that  are  less  serious,  as  in  the  psycho- 
neuroses.  When  one  treats  such  psychopaths  one  must  not  be 
pessimistic  and  discourage  them.  One  must  desire  them  to 
be  cured,  and  then  one  will  come  to  believe  in  the  possibility 
of  cure,  since  a  man  believes  so  easily  that  which  he  desires 
to  believe.  Faith  in  the  result  is  often  enough  to  produce  it. 


OF  NERVOUS   DISORDERS         439 


CHAPTER   XXXIV 

Etiology  of  the  Piychoneuroscs  —  The  Causes  the  Same  as  those  of 
Insanity  —  Definition  of  Nervousness  —  Predisposition,  Heredity,  and 
Natural  Disposition  —  Relation  of  Nervousness  to  Physical  Debility 
— Anemia,  Arthritism  or  Herpetism,  and  Cholemia — Purely  Somatic 
Origin  of  Certain  Psychoneuroses  —  Advantages  of  a  Persevering 
Psychotherapy  —  Necessity  of  Making  it  Rational 

VARIOUS  treatises  on  pathology  devote  their  introductory 
chapters  to  questions  of  etiology.  An  enumeration  of  causes 
follows  close  upon  the  summary  definition  of  the  morbid  entity 
that  is  studied.  This  plan  of  exposition  is  rational  when  it 
concerns  well-defined  diseases,  the  causes  of  which  are  known. 
In  general  such  chapters  on  etiology  are  not  remarkable  for 
their  clearness  even  in  relation  to  the  commonest  diseases ;  on 
reading  them  we  are  chiefly  impressed  with  our  ignorance. 

As  for  the  complex  pathological  conditions,  such  as  the 
psychoneuroses  which  we  have  just  studied,  it  would  be  foolish 
to  start  with  the  definition  and  enumeration  of  causes.  Be- 
fore summing  up  the  etiology,  one  must  have  detected  the 
varied  pathogeny  of  the  troubles  observed,  the  progress  of  the 
disease,  and  the  variations  which  it  presents  in  its  course, 
which  is  often  lengthy. 

The  fact  of  obtaining  the  same  result  from  various  physical 
and  psychical  treatments  throws  a  new  light  on  the  nature  of 
the  disease  and  on  the  causes  which  have  given  birth  to  it. 
Thus  the  sudden  disappearance  of  a  pathological  condition 
under  some  suggestion  argues  in  favor  of  the  psychic  origin 
of  the  disease.  The  experiences  of  the  school  of  Nancy  have 
thrown  most  light  upon  the  pathogeny  of  the  psychoneuroses. 
It  is  a  pity  that  they  have  not  known  how  to  use  these  definite 
ideas  to  better  advantage,  and  that  they  continue  to  extol  elec- 
tricity in  the  treatment  of  a  psychosis  that  is  as  pronounced  as 


440  PSYCHIC   TREATMENT 

hysteria.  They  are  still  on  the  lookout  for  new  physical 
measures;  they  have  used  the  Roentgen  rays,  and  now  the 
wonderful  discovery  of  M.  and  Mme.  Curie  has  been  vulgar- 
ized in  the  worst  sense  of  the  word  by  the  therapeutic  use  of 
radium!  Incredible,  but  true! 

It  is,  therefore,  at  the  end  of  these  lectures,  after  having 
described  the  disease,  and  after  having  already  expressed  a 
great  many  etiological  views,  and  having  based  my  work  on 
the  results  obtained  by  psychotherapy,  that  I  wish  to  try  to 
sum  up  the  etiology. 

I  do  not  hesitate  to  say  that  the  causes  of  the  psychoneu- 
roses  and  of  nervousness  are  the  same  as  those  of  insanity. 
To  get  a  complete  list  of  these  causes  we  need  only  turn  to 
the  table  of  contents  of  the  work  of  Toulouse,1  which  reads  as 
follows : 

Native  predisposition  |Heredlty|  unlike, 
(or  acquired)  ?  j  Congenital  factors. 

''Social:  environment. 
Biological:  age,  sex. 

Physiological:  menstruation,  puerperium. 
Moral:  emotions. 


Direct  causes  or  pro- 
vocative agents. 


Physical:  meteorlogical  influences,  traumatism. 


f  Intoxications. 

Infections. 
Pathological  •{  Constitutional  diseases. 

Visceral  diseases. 
[Nervous  diseases. 

I  put  an  interrogation  point  after  "  Acquired  predisposi- 
tion," to  which  Toulouse  devotes  a  few  indefinite  lines.  It  is 
impossible  for  me  to  associate  these  two  words,  "  predisposi- 
tion "  and  "  acquired."  That  which  is  acquired  after  birth 
is  a  pathological  condition  which  can  in  its  turn  play  the  role 
of  provocative  agent. 

Charcot  has  already  summed  up  the  whole  question  in  his 
clean-cut  style  by  saying :  "  The  neuroses — he  had  hysteria  in 
mind — arise  from  two  factors ;  the  one,  essential  and  invariable : 
neuropathic  heredity;  the  other,  contingent  and  polymorphic: 
the  provoking  agent. 


1  Ltt  causes  de  lafolie,  prophylaxie  el  assistance.    Edouard  Toulouse.     Paris,  1896. 


OF   NERVOUS   DISORDERS          441 

It  is  true  that  this  formula  is  as  comprehensive  as  it  is 
concise;  it  could  be  applied  to  all  diseases,  for  pathogenic 
agents  act  differently  according  to  the  predisposition  of  the 
subject.  It  applies  particularly  to  the  group  of  affections 
which  we  have  been  studying,  but  the  formula  must  be  modi- 
fied. The  term  "  psychopathic "  ought  to  replace  that  of 
"  neuropathic."  In  short,  as  the  predisposition  is  not  always 
hereditary,  it  may  sometimes  be  created  by  factors  which  have 
acted  on  the  child  during  its  fetal  life.  I  would  say: 

Nervousness  arises  from  two  factors :  the  one,  essential 
and  variable — viz.,  natural  psychopathic  tendencies  (hereditary 
or  acquired  in  fetal  life)  ;  the  other,  contingent  and  polymor- 
phic— viz.,  provocative  agents. 

The  word  "  innate "  is  employed  here  in  another  sense 
from  that  which  is  given  to  it  by  Lucas.1  This  author  opposes 
natural  tendencies  to  heredity.  The  latter  would  mean  for  us  a 
tendency  to  imitation,  to  the  reproduction  of  a  previous  type, 
while  natural  tendencies  would  constitute  what  was  new  in  us, 
something  spontaneous  which  had  escaped  the  law  of  heredity. 

For  myself,  however,  in  speaking  of  natural  tendencies,  I 
simply  wish  to  establish  the  fact  that  we  are  born  endowed 
with  certain  physical,  intellectual,  and  moral  qualities.  They 
are  transmitted  to  us  almost  in  their  entirety,  and  more  often 
the  term  heredity  could  be  substituted  for  that  of  natural 
tendencies.  I  prefer  the  second  because  it  leaves  a  place  for 
the  biological  changes  which  may  take  place  before  birth,  out- 
side of  the  pale  of  heredity,  by  traumatisms,  or  by  intoxications 
acting  on  the  fetus.  We  can  prove  this  natural  predisposition 
in  certain  cases,  and  we  foresee  it  in  others.  In  short,  we  ad- 
mit it  theoretically  and  presuppose  its  existence. 

We  sometimes  detect  in  a  person  who  believes  himself 
to  be  in  good  health  certain  mental  defects  which  make  us 
fear  the  development  of  psychopathic  conditions  in  the  future. 
When  this  psychic  crisis  appears  it  does  not  astonish  us,  and 
the  public  themselves  often  say  afterward  concerning  such 
patients :  "  Oh,  he  has  always  been  queer  and  original ;  "  or, 


1  Traitl  philosophigue  et  physiologique  de  thfrtdite  naturtllt.      Dr.  Prosper  I,ucas. 
Paris,  1847. 


442  PSYCHIC   TREATMENT 

"  He  has  always  had  a  weak  will  and  a  tendency  to  depression." 
It  was  a  pathological  condition  rather  than  a  predisposition 
that  they  recognized  in  the  subject,  and  it  had  merely  been 
aggravated  under  the  influence  of  provocative  agents.  We 
foresee  the  predisposition  even  tho  all  actual  symptoms  may 
be  absent.  In  subjects  whose  heredity  is  to  be  suspected, 
they  run  a  greater  chance  of  succumbing  under  pathological 
influences,  and  even  tho  an  accident  occurs,  heredity  would 
seem  to  be  a  sufficient  cause.  We  suppose — in  fact,  we  theo- 
retically admit — such  predisposition  when  we  see  a  patient 
unexpectedly  overcome  by  a  succession  of  events  which  would 
not  have  produced  the  same  reaction  in  other  individuals.  We 
infer  by  induction  that  this  latent  predisposition  was  there. 

This  predisposition  is  innate,  which  fact  it  is  wise  to  bear 
in  mind,  for  we  ought  to  practise  orthopedia  from  the  cradle. 
The  task  is  difficult,  for  we  are  not  content  with  transmitting 
our  defects  to  our  children,  we  give  them  the  contagious  ex- 
ample of  our  faults.  Such  natural  mental  tendencies  must  be 
physical,  or,  rather,  psychophysical  in  their  essence.  Our  par- 
ents do  not  bequeath  ready-made  qualities  to  us,  such  as  virtues 
or  vices ;  they  only  give  us  a  more  or  less  well-constructed 
brain,  capable  of  reacting  promptly  and  accurately  to  the 
various  stimuli  which  cause  its  activity. 

It  is  chiefly  to  heredity  that  we  owe  our  figure,  our  bony 
structure,  our  muscles,  and  our  entire  nervous  system.  We 
find  in  our  children,  often  from  their  very  birth,  our  traits, 
the  expression  of  our  faces,  our  gestures,  our  light  or  elastic 
step  or  our  heavy,  awkward  gait.  We  all  have  our  family  and 
racial  characteristics,  and  this  heredity  includes  our  moral 
as  well  as  our  intellectual  qualities  and  our  characters  as  well 
as  our  minds. 

Under  the  sway  of  spiritualistic  conceptions  we  have  re- 
fused for  a  long  time  to  accept  this  statement.  We  are  obliged 
to  accept  our  physical  and  intellectual  limitations,  but  we  like 
to  put  our  moral  qualities  in  a  separate  class.  We  want  to 
feel  that  they  are  ruled  by  a  free  power,  and  we  conclude  that, 
altho  everybody  can  not  be  well  made  from  a  bodily  point  of 
view,  and  strong  and  supple,  and  tho  we  can  not  all  have  the 


OF  NERVOUS   DISORDERS          443 

highest  minds  and  intelligence,  we  can  all  of  us  be  good  and 
adapt  our  life  to  the  laws  of  morality. 

Nothing  is  more  false.  Without  doubt  one  may  be  poorly 
endowed  physically  and  intellectually,  and  yet  have  all  the 
qualities  of  a  good  heart.  There  are  weak-minded  persons 
for  whom  we  feel  a  strong  sympathy  because  they  are  loving 
and  good.  They  redeem  their  intellectual  weakness  by  their 
moral  superiority.  On  the  other  hand,  the  world  is  full  of 
people  who  seem  to  be  favored  by  nature,  who  are  even  bril- 
liant in  their  intelligence,  but  who  are  destitute  of  moral  sense. 
Even  in  the  cradle  one  can  detect  a  child's  natural  defects. 
One  child  is  selfish  and  violent,  while  another  is  gentle  and 
amiable.  From  the  earliest  years  we  notice  irritability,  sus- 
ceptibility, and  a  tendency  to  rebellion.  Our  ancestors  be- 
queath to  us  a  certain  capital  of  qualities  and  characteristics, 
and  on  that  we  must  live  and  make  it  productive  by  wise 
administration. 

The  psychoneuroses  thus  have  a  physical  substratum,  and 
it  is  only  natural  that  they  should  have  been  attributed  to  so- 
matic causes.  The  same  question  is  put  concerning  the  in- 
sanities, of  which  many  are  caused  by  cerebral  affections  as 
well  as  moral  diseases.  Heinroth,  in  Germany  (1773-1843), 
admitted  that  madness  had  its  origin  in  the  absence  of  morality, 
and  that  its  essential  character  was  the  loss  of  liberty.  He 
considered  the  best  preservative  against  it  to  be  a  firm  hold 
on  the  truths  of  the  Christian  religion.1 

I  have  gone  over  these  questions  in  speaking  of  psycho- 
physical  parallelism  and  of  monism.  Throughout  this  entire 
work  I  have  tried  to  show  how  little  account  I  take  of  all  the 
theories  which  try  to  locate  the  cause  of  nervousness  in  alter- 
ations of  the  splanchnic  organs.  I  will  not  discuss  them  again, 
but  I  will  still  look  into  a  few  less  startling  hypotheses  which 
I  have  seen  defended  by  distinguished  physicians. 

First  of  all  they  consider  bodily  weakness,  or  exhaustion 
and  fatigue  to  be  the  cause.  I  am  opposed  to  this  view.  Phys- 
ical weakness  does  not  imply  psychasthenia.  One  may  be  puny, 


1  Dallemagne,  loc.  cit. 


444  PSYCHIC  TREATMENT 

anemic,  or  phthisical,  and  yet  have  a  brave  spirit ;  and  men  who 
enjoy  perfect  bodily  health  may  be  as  impressionable  as  ladies 
of  leisure.  It  is  true,  however,  that  any  one  who  has  a  psy- 
chopathic predisposition,  or  has  already  shown  some  symp- 
toms of  psychoneurosis,  is  apt  to  find  his  condition  aggravated 
under  the  influence  of  fatigue  and  weakness.  That  is  why  it 
is  reasonable  to  combine  with  psychotherapeutic  treatment  cer- 
tain physical  measures  intended  to  strengthen  the  body,  such 
as  rest  and  good  food. 

Nervousness  has  also  been  attributed  to  anemia,  and  every 
day  I  meet  ladies  who  tell  me,  on  the  word  of  their  physicians : 
"  Doctor,  I  am  anemic,  but  I  can  not  take  iron !  "  Here  I  pro- 
test even  more  energetically  than  I  do  against  fatigue.  Anemia 
does  not  even  deserve  a  place  among  the  provoking  agents  of 
nervousness.  For  many  years  I  have  examined  the  blood 
of  all  my  patients  by  the  aid  of  the  hemoglobinometer  of  Pro- 
fessor Sahli,  and  I  have  found  that  in  the  immense  majority 
of  cases  patients  afflicted  with  psychoneurosis  were  not  at 
all  anemic.  On  the  other  hand,  the  true  anemics — as,  for  in- 
stance, the  chlorotics — in  whom  the  percentage  of  hemoglobin 
may  fall  as  low  as  thirty  and  twenty-five,  did  not  have  at  all 
the  same  symptoms.  Their  feelings  of  weakness,  anorexia, 
dyspepsia,  their  cephalalgias,  and  their  respiratory  and  cardiac 
troubles  had  only  a  distant  relation  to  the  functional  disorder 
— nervousness.  We  do  not  find  in  these  patients  any  prepon- 
derating influence  of  mental  representations ;  they  do  not  have 
the  characteristic  stigmata. 

In  short,  in  the  rare  cases  where  anemia  is  a  complication 
of  nervousness,  the  independence  of  the  two  conditions  is 
manifested  by  the  fact  that  the  cure  of  the  anemia  (by  iron 
or  arsenic)  does  not  in  any  wise  lead  to  the  cure  of  the  nervous 
symptoms.  I  have  even  seen  a  hysteroneurasthenic  patient 
forget  her  nerves  in  the  course  of  an  anemia  following  uterine 
hemorrhages  (50  per  cent,  hemoglobin),  and  remember  them 
on  the  very  day  when  the  blood  had  regained  its  normal 
qualities.  These  facts  are  so  unquestionable  to  me  that  I  do 
not  hesitate  to  say  to  such  patients :  "  You  are  anemic  and 
nervous.  I  will  try  to  cure  your  anemia;  but  do  not  labor 


OF  NERVOUS   DISORDERS         445 

under  any  delusion:  this  physical  improvement  will  not  be 
enough  to  cure  you  of  nervousness.  You  will  feel  better,  and 
this  better  state  of  health  will  make  the  task  easier;  but  you 
can  only  get  rid  of  your  trouble  by  educating  yourself !  " 

The  question  of  the  etiology  of  the  psychoneuroses  becomes 
more  difficult  when  one  looks  at  the  relation  of  nervousness  to 
arthritism  and  herpetism. 

Certain  distinguished  clinicians  and  practitioners  who  have 
been  able  to  follow  the  diathetic  influences  in  some  families 
hold  that  there  is  a  relation  between  nervousness  and  arthritism. 
I  do  not  deny  the  exactness  of  these  statistical  statements, 
altho  the  information  on  which  they  are  based  often  seems  to 
me  very  superficial.  But  I  would  remark,  first  of  all,  that, 
when  two  pathological  conditions  are  so  frequent  that  few 
people  escape  them,  it  is  easy  to  find  them  coexisting  in  the 
same  individual  or  in  his  ancestors  or  his  descendants.  This 
in  no  wise  authorizes  us  to  establish  a  relation  of  cause  and 
effect  between  the  two. 

When  they  place  in  the  same  class  with  herpetism  1  not 
only  cutaneous  lesions,  exanthematous  herpetides,  and  the  ar- 
thritides,  but  also  lesions  of  the  hair  and  of  the  nails,  catarrhs 
of  the  mucous  membrane  resembling  exanthematous  herpe- 
tides, osteitides,  muscular  affections,  cramps,  lesions  of  the 
veins  and  arteries,  varices,  hemmorrhoids  and  arteriosclerosis, 
they  have  enumerated  nearly  all  the  constitutional  affections.  I 
do  not  know  any  person  in  whom  one  could  prove  at  a  certain 
age  the  absence  of  all  lesions  of  this  nature;  one  would  find 
them  in  any  case  in  some  person  of  the  family.  On  the  other 
hand,  it  is  difficult  to  find  a  man  free  from  all  symptoms  of 
nervousness.  The  coincidence  of  these  two  conditions  is, 
therefore,  not  astonishing.  Does  that  mean  that  there  is  no 
truth  in  these  etiological  views  expressed  by  these  dogmas  of 
French  medicine?  No. 

There  are  diatheses  and  characteristic  human  types,  altho 
it  is  difficult  to  portray  their  clinical  picture.  There  is,  in  par- 
ticular, an  arthritic  type.  They  are,  in  general,  people  of  rather 
strong,  even  vigorous,  constitutions  who  at  first  sight  have  the 

1  TraiU  de  Therpttismc.    Dr.  I«ancereaux,  1883. 


446  PSYCHIC  TREATMENT 

appearance  of  good  health,  but  they  are  subject  to  a  whole 
series  of  physical  troubles.  They  have  a  tendency  to  eczema, 
to  catarrhs  of  the  mucous  membranes,  they  are  subject  to 
muscular  rheumatism,  varices,  and  hemorrhoids;  they  may, 
when  the  diathesis  is  more  manifest,  present  some  articular 
or  para-articular  lesion.  And,  lastly,  they  have  a  tendency  to 
become  stout;  often  they  have  alimentary  glycosuria,  and  be- 
come arteriosclerotic  as  they  grow  old. 

Tormented  by  these  troubles,  which  are  not  very  serious, 
such  persons  are  inclined  to  a  certain  degree  of  pessimism. 
They  become  bad  tempered,  irritable,  and  peevish;  their  phi- 
losophy is  exhausted  under  the  influence  of  continual  discom- 
fort, and  they  tend  to  become  hypochondriacal. 

I  would  go  still  further  and  say  that  such  nervousness  is 
not  only  secondary,  and  appears  later  as  a  result  of  continued 
suffering;  but  I  would  even  admit  that  the  diathetic  state 
might  act  directly  on  the  brain  as  it  has  acted  on  the  skin, 
the  mucous  membrane,  and  the  joints,  and  that  it  might  thus 
create  a  psychasthenic  condition.  But  we  have  no  decisive 
proof,  and  we  are  reduced  to  conjectures  and  impressions 
which  we  too  often  transform  into  aphorisms  which  are  des- 
tined to  a  precarious  life. 

I  will  confess,  purely  from  the  point  of  view  of  the  prac- 
titioner, that  the  subject  does  not  interest  me  very  much.  The 
clinical  ideas  are  too  uncertain  to  permit  any  conclusions. 
Moreover,  there  is  a  very  practical  reason  which  makes  me 
neglect  this  problem — viz.,  if  one  were  to  make  nervousness 
depend  upon  a  general  diathetic  condition,  I  should  be  dis- 
couraged at  the  start.  We  all  know  how  difficult  it  is  to 
correct  these  constitutional  tendencies  and  to  combat  a  dia- 
thesis, and  if  I  had  considered  the  psychoneuroses  to  be  so 
rebellious  I  would  have  thrown  up  the  whole  business  long 
ago.  My  patients  would  not  have  waited  for  a  sign  of  dis- 
couragement from  me.  They  would  no  longer  have  come 
to  me. 

In  speaking  of  the  prophylaxis  of  herpetism,  Lancereaux 
writes :  "  Unfortunately,  our  ignorance  of  etiological  condi- 
tions other  than  heredity  places  us  in  the  position  of  not  being 


OF   NERVOUS   DISORDERS          447 

able  to  say  exactly  what  we  ought  to  do  in  such  cases.  I 
believe,  nevertheless,  that  it  is  well  to  submit  children,  from 
their  earliest  age,  to  a  severe  routine  of  hygiene,  to  try  to 
moderate  their  nervous  system  by  making  them  take  baths 
and  gymnastic  exercises  and  hydrotherapeutic  treatment,  and 
sometimes  even  putting  them  on  a  bromide  treatment." 

One  must  admit  that  this  is  not  very  encouraging.  When 
the  prophylaxis  is  so  poor,  what  can  one  say  of  the  therapeutic 
measures  which  have  to  do  with  old  lesions  due  to  heredity, 
and  aggravated  by  thirty  or  forty  years'  lack  of  hygiene,  or 
else  which  have  persisted  in  spite  of  good  hygiene  ?  Let  us  ad- 
mit that  in  man  the  struggle  against  diatheses  is  arduous.  Even 
in  the  animal  it  is  difficult,  altho  we  have  the  resources  of  se- 
lection and  of  crossing. 

The  stigmata  of  the  psychoneuroses  are  too  psychic,  the 
functional  troubles  are  too  dependent  upon  mental  represen- 
tations, to  be  attributed  merely  to  a  flaw  in  the  constitution  of 
the  tissues  or  to  the  condition  of  humors.  A  man  is  not  neur- 
asthenic and  hypochondriac  because  he  is  cachochymic.  He 
is  neurasthenic  on  account  of  what  he  owes  to  heredity,  to 
atavism,  to  education,  and  to  his  ego. 

I  have  shown  in  a  little  leaflet *  the  evident  influence  that 
the  body  exercises  on  the  mind,  but  I  have  pointed  out  that 
the  inverse  influence  is  still  more  powerful.  Experience  has 
proved  to  me  that,  by  acting  on  the  mind,  one  can  improve 
and  cure  the  psychoneuroses,  even  when  it  is  impossible  to 
modify  the  diathetic  conditions  which  accompany  them.  It 
is  this  encouraging  idea  that  has  urged  me  along  the  path  of 
rational  psychotherapy,  and  I  shall  persist  in  it,  even  if  new 
researches  should  succeed  in  showing  a  certain  bond  between 
the  mental  conditions  and  organic  chemistry.  That  would  in 
no  wise  hinder  me  from  using  moral  suasion ;  for  it  leads  too 
directly  to  success  for  me  to  abandon  it.  By  no  means  would 
a  new  theory  of  cholemia  2  stop  me. 


1  De  r influence  def  esprit  sur  le  corps.    46  edition.    Berne,  1904. 

*  Note  sitr  la  psychologic  des  cholemiques.  La  neurasthinie  biliare.  Par.  MM.  A. 
Gilbert  et  P.  Lereboullet  (Bulletin  et  mtJmoires  de  la  Societe  medicale  des  hopitaux 
de  Paris,  6  aout,  1903). 


448  PSYCHIC  TREATMENT 

First  of  all,  I  am  not  persuaded  that  it  would  be  so  easy 
to  reveal  the  presence  of  small  quantities  of  bile  in  the  blood 
serum.  The  yellow  coloration  would  seem  to  be  difficult  to 
establish  in  a  liquid  which  already  contains  yellow  coloring 
material.  The  reaction  of  Gmelin  would  be  a  better  test  if 
it  were  truly  characteristic.  But  tho  I  possessed  every  demon- 
stration of  the  cholemic  condition  of  the  blood,  it  would  prove 
to  me  only  one  thing — that  is,  that  neurasthenia,  like  melan- 
cholia, may  disturb  the  hepatic  functions.  It  would  not  be 
difficult  for  me  to  admit  this  after  having  proved  for  several 
years  that  all  the  organic  functions  feel  the  reaction  of  our 
emotions.  But  it  still  seems  like  putting  the  cart  before  the 
horse. 

Does  this  mean  that  all  nervous  conditions  are  only  brought 
about  by  psychic  means,  and  that  all  may  be  cured  by  the  treat- 
ment of  psychotherapy  ?  Alas,  no !  There  are  many  nervous 
patients  who  submit  so  easily  to  the  influence  of  advice  that 
one  would  say  that  they  are  only  afflicted  by  a  disease  of  the 
mind.  There  are  others  in  whom  one  recognizes  somatic  and 
psychical  influences;  and,  lastly,  there  are  psychoneurotics 
who  have  in  the  very  organization  of  their  brain  certain  dis- 
eased conditions  which  render  the  patient  absolutely  refrac- 
tory to  all  psychotherapeutic  action.  There  are  neurasthenic 
and  hysterical  patients  who  remain  incurable,  in  spite  of  every 
effort  which  they  try  to  make  to  modify  their  mental  state. 
Melancholia  and  hypochondria  often  occur  without  any  per- 
ceptible moral  cause  under  the  sole  influence  of  troubles  whose 
nature  is  unknown. 

The  periodic  depression  of  Lange  may  establish  itself 
under  the  influence  of  the  seasons,  and  present  a  periodicity 
which  is  so  regular  that  it  reminds  one  of  epilepsy.  I  have 
described *  two  cases  of  periodic  depression,  in  which  at- 
tacks of  a  neurasthenic  and  melancholic  nature  appeared  with 
the  regularity  of  a  tertian  intermittent  fever.  One  of  these 
patients,  a  nun,  had  had  for  twenty-two  years  alternating  good 
and  bad  days. 


1  "  Ueber    intermittirende    psychopathische    ZustSnde."       Correspondzblatt  fur 
Schmeiter  Aersle,  No.  9,  1901. 


OF  NERVOUS   DISORDERS         449 

The  other,  a  man  of  good  constitution,  fifty-eight  years 
of  age,  had  been  attacked  three  years  previously,  and  the  bad 
days  had  succeeded  the  good  ones  with  perfect  regularity. 
After  having  passed  a  normal  day  in  a  state  of  perfect  health, 
without  any  agitation,  our  patient  would  go  to  bed  at  ten 
o'clock.  He  would  sleep  quietly,  and  awaken  toward  five 
o'clock  in  the  morning  disturbed  by  a  slight  dyspnea.  His 
pulse  would  be  accelerated  by  several  beats;  his  skin  would 
become  moist;  he  had  polyuria  and  pollakiuria;  the  second 
day  would  pass  in  a  state  of  complete  aboulia  (lack  of  will- 
power), the  patient  would  be  bad  tempered  and  would  only 
talk  of  his  death.  He  would  not  be  able  to  read  a  paper  nor 
give  an  order.  He  would  suffer  martyrdom.  A  slight  im- 
provement would  follow  his  midday  meal.  In  the  evening, 
toward  five  o'clock,  he  would  be  able  to  smoke  a  cigar  and 
glance  at  the  paper.  He  would  go  to  bed  again,  pass  a  normal 
night,  and  would  wake  up  in  the  morning  a  new  man.  This 
intermittent  psychosis  had  yielded  neither  to  the  rest  cure, 
with  overfeeding  and  massage,  nor  to  psychotherapy.  Opium 
alone  could  act  as  a  palliative,  not  by  changing  the  periodicity, 
but  by  relieving  his  misery. 

It  is  evident  that  in  cases  of  this  kind  the  mental  condition 
is  complicated  by  somatic  causes  absolutely  independent  of  the 
will  of  the  patient.  It  is  the  same  way  in  the  majority  of 
cases  of  true  involution  melancholia,  and  then  one  must  de- 
pend upon  the  excellent  effect  of  opium  when  the  most  benefi- 
cent psychotherapy  can  not  succeed  in  arousing  the  patients 
from  their  sadness.  I  have  shown,  on  the  other  hand,  that 
there  are  cases  of  mild  hypochondriasis  and  hypomelancholia 
in  which  a  little  good  advice  is  of  more  use  than  narcotics. 
Here  we  stand  at  this  ill-defined  boundary  line  which  sepa- 
rates the  insanities  from  the  psychoneuroses.  When  the  trouble 
is  of  somatic  origin,  I  must  say  that  it  is  greatly  to  be  regretted, 
because  we  know  so  little  about  the  minute  internal  causes 
which  disturb  the  cerebral  functions,  and  we  are  wholly  dis- 
armed in  the  presence  of  such  constitutional  psychoses. 

I  ought  to  add,  however,  that  these  cases  are  rare  in  the 
clientele  of  the  neurologists.  Even  when  we  are  obliged  to 


450  PSYCHIC   TREATMENT 

recognize  the  corporal  causes  of  the  trouble  we  can  still  act 
on  the  mind,  and  in  this  way  stimulate  the  cerebral  functions. 
As  I  have  said,  ideas  work  as  an  antidote.  But  one  must  know 
how  to  be  patient,  and  at  the  same  time  firm  and  gentle,  with 
these  patients.  One  never  errs  by  too  great  perseverence.  One 
should  never  give  up  and  admit  the  material  nature  of  the 
trouble  which  darkens  the  prognosis  until  one  is  pushed  to 
the  last  extremity. 

In  short,  the  question  of  knowing  whether  the  psychoneu- 
roses  and  the  psychoses  have  a  somatic  origin,  or  whether 
they  depend  upon  the  mental  life,  has  not  much  practical  im- 
portance. It  would  have  an  enormous  value  the  moment  one 
discovered  a  toxin  which  could  produce  these  states  and  which 
could  be  neutralized.  We  are  very  far  from  such  a  discovery, 
and  these  are  only  the  lucubrations  of  our  chemistry  which 
we  approach. 

For  my  part,  I  have  the  opportunity  daily  to  prove  the 
inefficacy  of  physical  treatments  and  the  dangers  to  which 
they  subject  the  patient.  Even  in  the  cases  where  they  act 
favorably,  it  is  easy  to  recognize  the  influence  of  suggestion. 
And,  lastly,  in  the  very  cases  which  have  resisted  all  treat- 
ment, and  which  have  even  been  aggravated  by  it,  I  have  been 
able  to  prove  the  power  of  psychotherapy. 

I  have  shown  that  it  acts  in  various  ways;  faith  in  the 
cure  may  become  established  under  the  influences  of  any 
suggestions  whatsoever.  I  hold  that  the  earnest  physician 
ought  to  endeavor  to  purify  this  psychotherapy,  and  make  it 
more  rational  and  more  moral  in  its  nature. 


OF   NERVOUS    DISORDERS          451 


CHAPTER   XXXV 

Conclusions — Views  on  Medicine  in  the  Twentieth  Century — Surgery — 
Internal  Medicine — Medicative  Therapeutics,  Physiotherapy — Con- 
stant Intervention  of  Psychotherapy:  Its  Necessity  in  the  Struggle 
Against  the  Psychoneuroses — The  Precepts  of  Physical.  Intellectual, 
and  Moral  Hygiene 

I  WONDER  whether  I  have  succeeded  in  this  book,  which 
has  perhaps  been  too  long  for  the  pleasure  of  my  readers, 
not  in  convincing  (that  would  be  too  great  an  ambition),  but 
in  clearly  setting  forth  my  thought.  It  is  not  for  me  to  say, 
but  I  hope  I  have  done  so.  If  I  have  sometimes  thrown  a 
little  too  much  animation  into  the  expression  of  my  opinions, 
I  hope  readers  will  pardon  me  in  remembering  that  I  am 
upholding  a  cause  to  which  I  have  devoted  my  whole  activi- 
ties for  a  quarter  of  a  century. 

I  have  by  no  means  enumerated  all  the  functional  troubles 
of  nervousness,  and,  far  from  being  able  to  indicate  the  course 
to  follow  in  each  one  of  them,  I  have  been  limited  in  my  illus- 
trations to  a  few  typical  observations.  I  believe,  however,  that 
this  treatise  contains  a  fair,  generalized  view  of  the  value  of 
psychotherapeutic  methods.  I  should  like  to  see  my  confreres 
enter  the  same  line  of  work,  and  analyze  such  psychopathic 
conditions  with  more  patience  and  detail  than  I  have  been 
able  to  do,  thereby  rendering  such  moral  treatment  still  more 
exact  and  efficacious. 

I  should  like  briefly  to  sum  up  my  ideas,  and  at  the  same 
time  express  some  of  my  views  on  the  medicine  of  the  twen- 
tieth century.  This  will  be  a  sort  of  medical  profession  of 
faith,  but  it  may  not  be  necessary  to  say  that  I  shall  hardly 
be  found  in  the  orthodox  camp. 

There  are,  and  there  always  will  be,  diseases  characterized 
by  pronounced  changes  of  tissues  or  organs,  treatment  of  which 


452  PSYCHIC   TREATMENT 

demands  the  exact,  prompt,  and  efficacious  intervention  of 
the  surgeon.  The  tuto,  cito,  and  jucunde  of  our  confreres  of 
the  bistoury  is  perhaps  slightly  exaggerated,  but  it  is  none 
the  less  true  that,  in  the  domain  of  therapeutics,  it  is  surgery 
that  keeps  us  back.  I  am  not  one  of  those  jealous  physicians 
who  seem  to  have  no  other  object  than  to  belittle  the  merit 
of  operators,  and  to  snatch  away  their  clients.  I  feel,  on  the 
contrary,  that  the  surgeon  does  not  go  far  enough,  and  that  he 
often  ought  to  put  what  we  euphoniously  call  armed  expec- 
tancy in  place  of  his  active  intervention. 

Whenever  there  is  pus  to  get  rid  of,  or  mechanical  obstacles 
to  overcome,  the  indications  are  explicit,  and  the  surgeon  ought 
more  frequently  to  attack  these  affections  of  the  splanchnic 
organs  that  are  so  often  mortal,  such  as  appendicitis,  the  vari- 
ous kinds  of  peritonitis,  stony  concretions  of  the  liver,  kidneys, 
and  intestines,  gastric  and  intestinal  ulcers,  intestinal  obstruc- 
tions, volvulus,  scars,  and  tumors. 

I  believe,  however,  that  there  is  no  need  for  me  to  stimulate 
the  ardor  of  surgeons.  They  will  go  ahead  alone.  But  since  I 
have  spoken  of  them,  I  should  like  to  recommend  to  them  a 
few  reflections  on  the  use  that  might  be  made  of  a  modest 
psychotherapy,  even  in  the  domain  of  manual  therapeutics. 
The  greatest  of  all  suffering  is  moral  suffering,  and  the  sur- 
geon can  do  a  great  deal  of  good  by  encouragement  and 
kindly  words.  He  sometimes  forgets  this  in  the  enthusiasm 
which  the  feeling  of  his  manual  dexterity  and  his  imperturb- 
able coolness  gives  him. 

In  the  field  of  internal  medicine  we  have  to  combat  general 
or  local  diseases — the  former  being  constitutional,  hereditary, 
or  acquired,  and  the  latter  due  to  the  influence  of  various 
causes.  Prophylaxis  should  play  the  first  role  in  this  struggle 
against  disease.  Unfortunately,  we  know  too  little  about  eti- 
ology, and  we  can  only  have  recourse  to  public  and  private 
hygiene,  which  require  a  long  time  to  take  effect,  and  are 
desperately  slow  in  results.  We  are,  therefore,  forced  to  fall 
back  upon  medicines,  and  rely  upon  physiotherapy  which  util- 
izes all  natural  agents  as  therapeutic  measures. 

Drug  therapy  has  kept  up  its  prestige  in  the  eyes  of  prac- 


OF  NERVOUS   DISORDERS         453 

titioners  and  the  public  for  a  long  time.  Nevertheless,  since 
the  days  of  antiquity  it  has  been  intimated  that  we  are  like  the 
augurs  who  could  not  think  of  themselves  without  laughing; 
we  are  sometimes  accused  of  lying  like  tooth-pullers.  We  hear 
old,  experienced  practitioners  say  to  their  younger  brothers: 
"  Hurry  up  and  use  this  medicine  while  it  is  still  efficacious." 
One  of  them,  and  one  of  the  most  distinguished,  too,  said: 
"  We  never  take  medicine  ourselves ;  we  sometimes  give  it  to 
our  friends,  and  always  to  our  patients." 

Are  not  these  mere  sallies  of  wit?  Let  us  beware;  when 
we  begin  to  make  fun  of  dogmas,  it  means  that  faith  is  waver- 
ing, and  it  must  be  acknowledged  that  we  have  helped  to  create 
the  situation.  Pharmacy  somewhat  resembles  those  arsenal 
museums  where  the  catapult  elbows  the  modern  cannon,  and 
it  is  like  going  there  to  choose  our  weapons.  We  are  not  very 
critical  in  our  choice,  but  it  does  not  seem  to  matter  much,  for 
we  have  fostered  genuine  medical  superstition  in  our  public. 

We  possess  a  few  rare  specifics  which  cure,  and  numerous 
palliatives,  but  this  useful  pharmacy  is  very  small.  These 
will  be  found  in  the  medicine-case  of  the  practising  physician 
in  the  form  of  a  few  compressed  tablets  or  alkaloids.  The 
most  celebrated  physicians  have  recognized  the  inadequacy 
of  our  medical  materials,  of  which  we  may  well  say :  "  There 
are  many,  but  not  of  much  use"  (Multa  non  multum).  A 
great  French  clinician  has  summed  up  this  thought  in  the 
words :  "  Medicine  sometimes  cures,  it  often  relieves,  it  al- 
ways consoles !  " 

I  have  heard  some  of  the  men  who  stand  highest  in  the 
medical  profession  admit  that  pharmaco-therapeutics  is  day  by 
day  losing  its  importance.  They  expect  very  little  in  that 
direction,  but  hope  for  everything  from  the  use  of  natural 
forces,  su:h  as  mechanotherapy,  scientifically  studied  hydro- 
therapy,  phototherapy,  electricity,  and  radio-therapy  by  those 
mysterious  rays  which  they  are  discovering  in  such  numbers 
that  soon  there  will  not  be  enough  letters  in  the  alphabet  to 
name  them  all. 

In  my  eyes  this  new  error  is  as  fatal  as  the  first:  it  is  only 
replacing  one  superstition  by  another.  Physical  agents,  such 


454  PSYCHIC   TREATMENT 

as  temperature,  light,  air,  and  the  various  radiations,  can 
act  favorably  on  the  health  in  natural  conditions.  When,  in 
order  to  use  them  in  behalf  of  patients,  we  concentrate  their 
action,  we  can  derive  some  profit  from  them  by  employing 
them  as  palliatives,  but  the  more  we  concentrate  them  and 
the  more  we  localize  this  action  the  more  desructive  they  be- 
come. The  normal  and  pathological  tissues  can  be  destroyed 
by  heat  and  cold,  the  solar  rays  or  the  rays  of  electrical  light, 
also  by  obscure  radiations  as  well  as  by  chemical  caustics,  hot 
irons  or  the  bistoury.  Thus  the  most  encouraging  results 
have  been  obtained  in  the  superficial  affections,  such  as  lupus 
and  cutaneous  cancers. 

One  must  keep  on  investigating  and  searching  after  truth, 
always  maintaining  a  scientific  skepticism  and  a  philosophic 
doubt. 

By  proceeding  thus  we  could  create  a  little  arsenal  both 
of  new  weapons  and  of  old  weapons  that  have  remained  use- 
ful. But  in  spite  of  that  we  shall  remain  defenseless  in  the 
presence  of  all  those  diseases  which  are  caused  by  heredity, 
bad  hygienic  conditions,  poverty,  immorality,  and  the  microbes 
which  multiply  in  the  air.  Thus  in  spite  of  the  colossal  effort 
of  workers  in  medicine,  the  morbidity  and  mortality  have 
scarcely  diminished.  This  is  a  pity,  but  it  would  be  silly  to 
try  to  delude  ourselves.  Humanity  progresses  very  slowly. 

I  have  shown  how  useful  in  this  domain  of  internal  medi- 
cine and  bodily  sickness  one  might  find  a  psychotherapy  that 
was  governed  by  tact  and  kindness.  Doubtless  it  is  still  noth- 
ing more  than  a  palliative,  like  many  medicines ;  but  it  can  be 
applied  to  that  element  of  suffering  which  constitutes  the 
whole  of  the  disease  as  far  as  the  patient  is  concerned.  That 
is  why — altho,  as  a  matter  of  fact,  the  prognosis  depends  upon 
the  lesion,  and  altho  moral  influence  does  not  cure — it  is  in 
such  psychic  therapeutics  that  the  physician  finds  the  most 
powerful  means  to  relieve  and  console  and  to  hasten  cure. 

Along  with  those  somatic  affections  which  constitute  the 
domain  of  internal  medicine  there  is  a  group  of  diseases  which 
have  been  called  psychoneuroses,  and  which  I  have  had  chiefly 
in  mind  in  this  work.  These  psychoneuroses  are  psychopathies. 


OF  NERVOUS   DISORDERS         455 

They  are  bounded  on  the  one  side  by  the  insanities,  on  the 
other  by  what  we  call  the  normal  condition.  There  is  scarcely 
any  more  danger  of  these  patients  degenerating  into  insanity 
than  there  is  for  healthy  men  developing  neurasthenia.  Placed 
at  the  middle  of  the  ladder,  or  still  lower  yet,  the  nervous  pa- 
tients have  more  chance  of  returning  to  the  normal  state  than 
of  progressing  toward  insanity. 

These  psychopathic  conditions  are  legion.  They  may  occur 
singly,  forming  an  imitation  of  morbid  entities,  such  as  neur- 
asthenia, hysteria,  hystero-neurasthenia,  hypochondria,  and 
melancholia,  and  conditions  of  disequilibrium  and  degeneracy; 
they  are  continually  mingling  themselves  in  the  symptoma- 
tology of  all  surgical  and  medical  diseases,  and  in  human  suf- 
fering under  all  its  forms  and  in  all  its  degrees. 

Properly  speaking,  there  is  no  physical  suffering;  it  is 
always  psychic,  even  when  it  results  from  a  traumatism  or 
an  anatomical  lesion.  We  suffer  in  our  sentient  ego ;  there  are 
the  facts  of  consciousness  interpolated  everywhere,  and  that 
is  why  the  role  of  psychotherapy,  properly  understood,  is  so 
large. 

While  medications  may  undergo  continual  modifications, 
and  skeptical  raillery  may  give  way  in  a  few  months  to  super- 
stitious faith;  while  we  witness  the  sorry  spectacle  of  our 
continual  new  remedies,  psychotherapy,  which  has  always  ex- 
isted, and  which  has  always  been  practised,  continues  its 
march  without  wavering.  It  varies  its  methods  in  a  thousand 
ways  according  to  the  psychological  moment,  but  it  always 
remains  the  same  in  its  tendency.  It  is  like  love,  which  nothing 
can  rebuff. 

In  neurasthenia  we  find  general  debility;  sometimes  it  is 
physical,  sometimes  intellectual,  but,  above  all,  it  is  moral. 
Our  endeavor  is  to  raise  up  these  patients,  to  give  them  confi- 
dence in  themselves,  and  to  dissipate  their  fears  and  their 
autosuggestions. 

In  the  great  majority  of  these  cases  we  can  reach  this  end 
by  moral  influence.  If  we  find,  along  with  mental  stigmata, 
certain  somatic  complications,  we  ought  to  combat  them  by 
hygiene  and  physical  measures  and  medicines.  But  we  must 


456  PSYCHIC   TREATMENT 

be  careful  to  tell  the  patient  that  these  physical  therapeutics 
have  no  direct  action  on  the  moral  trouble.  Much  more,  if  it 
is  only  a  question  of  functional  troubles  following  the  fall  of 
the  psychic  barometer,  take  care  to  treat  these  symptoms  by 
efficacious  means.  The  neurasthenic  ought  to  know  clearly 
that  he  is  psychopathic,  and  not  sick  in  his  body.  One  can  tell 
him  this  without  hurting  his  feelings  and  without  upsetting 
him.  I  have  said  that  this  psychotherapy  pure  and  simple  is 
facilitated  by  favorable  conditions,  such  as  isolation,  rest,  and 
overfeeding.  But  one  ought  not,  as  is  often  the  case,  to  con- 
found the  curative  agent  with  the  auxiliaries  which  favor  its 
action. 

Isolation  may  be  valuable  and  necessary,  but  it  works  no 
cure  in  itself;  rest  may  of  itself  dispel  the  symptoms  of  the 
actual  condition,  and  lead  to  temporary  cure;  but  it  is  never 
definitely  efficacious,  for  it  does  not  free  the  patient  from  his 
impressionability,  his  mental  instability,  or  his  lack  of  logic. 
More  or  less  crude  suggestion  may  succeed,  but  it  is  insuffi- 
cient if  one  takes  the  future  of  the  subject  into  account.  The 
only  thing  that  will  assure  the  future  of  the  patient  is  a  rational 
moralizing  psychotherapy  which  will  change  the  psychopathic 
mentality  which  has  determined  the  symptoms. 

To  cure  hysterics  the  physician  must  be  still  more  firm  in 
his  course;  he  must  not  fear  to  be  extreme  in  his  views  con- 
cerning the  pathogeny.  When  he  is  with  patients  imbued  with 
their  autosuggestions,  he  must  get  at  the  keynote  of  their 
trouble  and  find  out  how  to  get  hold  of  it.  This  ought  to  be 
the  fundamental  idea.  Everything  in  hysteria  proceeds  from 
mental  representation.  An  hysterical  person  is  an  actor  who 
has  lost  his  head  and  plays  his  part  imagining  that  it  is  real. 
One  must  know  how  to  help  him,  to  show  him  his  error,  just 
as  one  would  stop  the  comedian  who  was  ready  to  plunge  a 
dagger  into  his  breast.  But  this  recall  to  real  life  ought  to  be 
made  with  gentle  firmness.  People  coming  out  of  a  dream 
have  a  very  sensitive  mentality ;  they  are  frightened  by  a  ges- 
ture or  by  a  sharp  word.  With  an  hysterical  person  one  must 
act  as  with  an  epileptic  who  comes  out  of  a  trance;  one  must 
not  stare  at  him  or  jump  up  quickly,  or  speak  to  him  roughly. 


OF  NERVOUS   DISORDERS         457 

One  must  learn  not  to  change  one's  position,  and  to  put  a 
question  gently,  without  raising  the  voice,  in  such  a  way  that 
the  wakening  does  not  take  place  roughly.  Then  the  patient 
comes  to  himself;  he  is  quieted  by  the  kindly  faces  of  those 
who  are  present ;  he  recognizes  his  surroundings,  and  recovers 
his  normal  identity  without  any  sense  of  shock. 

I  do  not  know  any  physical  or  medical  treatment  for  hys- 
teria. The  method  of  attacking  isolated  symptoms  not  only 
exposes  one  to  numerous  setbacks,  but  it  also  compromises  the 
future.  Hysteria  only  becomes  chronic  when  it  is  left  to  itself 
(it  has  no  tendency  to  get  well  alone),  or  when  it  is  encour- 
aged, or  continually  revived  by  badly  understood  medical  treat- 
ment. The  hysterical  person  lives  in  a  state  of  self-deception. 
We  must  bring  him  back  to  the  truth.  Neither  douches  nor 
strychnine  will  be  of  any  value  in  convincing  him  of  his  error. 

Serious  hypochondrias  and  melancholias  ought  to  be  treat- 
ed in  asylums,  but  I  have  shown  that  there  are  some  mild 
forms  which  we  can  care  for  without  danger  to  the  patient. 
I  even  hold  that  daily  psychotherapic  conversation  can  hasten 
the  cure  considerably.  But  here  again  one  must  not  leave  the 
question  open  to  doubt.  The  patients  ought  to  know  that  they 
are  psychopaths.  One  must  not  let  them  have  any  ground  on 
which  to  base  their  fears  by  caring  for  their  stomachs,  or  their 
hearts,  or  the  organ  of  which  they  complain.  One  must  take 
care  not  to  set  before  them  theories  of  intoxication  and  to 
make  them  look  for  cure  through  a  milk  diet,  or  a  vegetarian 
regime,  or  intestinal  antisepsis.  One  can  tell  them,  what  is 
true,  that  we  still  know  nothing  of  the  somatic  causes  of 
these  conditions,  that  good  hygiene,  rest,  healthful  food,  and 
even  opium  can  act  favorably  on  their  condition,  but  the  role 
of  the  physician  is  first  of  all,  as  Pinel  has  said,  to  start  the 
work  of  logical  reflection. 

There  are  also  some  unbalanced  people  who  have  to  be 
morally  supported  if  they  are  to  be  freed  from  their  manias, 
obsessions,  and  fears.  To  propose  treating  these  mental  pa- 
tients by  baths,  douches,  electricity,  and  cacodylate  of  soda  is 
just  as  absurd  as  to  give  digitalis  to  a  person  who  has  palpi- 


458  PSYCHIC   TREATMENT 

tation  of  the  heart  at  the  sight  of  a  dog;  it  would  be  much 
better  to  prove  to  him  that  dog  does  not  bite. 

Undoubtedly  this  kind  of  work  is  difficult,  and  not  all 
patients  can  be  cured.  But  it  is  the  only  way.  The  physician 
has  nothing  to  help  him  but  his  concise,  imperturbable,  and 
kind  utterances.  All  such  psychoneurotics  ought  to  be  brought 
back  to  a  healthy  life  and  to  the  requirements  of  physical,  in- 
tellectual, and  moral  hygiene. 

Public  and  private  hygiene  are  very  simple  in  their  ten- 
dencies; they  are  of  a  negative  nature — that  is  to  say,  they 
consist  not  in  doing  something  for  the  health,  but  in  not  doing 
anything  to  compromise  health. 

In  the  growth  of  our  towns  one  distinct  object  should  be 
kept  in  mind  which  can  only  be  slowly  accomplished  by  the 
help  of  engineers  and  chemists  and  by  our  wise  men  in  general. 
Even  in  the  country  there  is  work  to  be  done  in  making  soil 
and  dwellings  sanitary,  in  struggling  at  the  same  time  against 
natural  obstacles  and  those  which  are  brought  about  by  living 
together.  It  should  not  have  for  its  end  the  creation  of  new 
and  hyperidealistic  conditions,  but  rather  the  suppression  of 
what  is  bad. 

Private  hygiene  does  not  consist  at  all,  as  so  many  people 
seem  to  believe,  in  making  a  great  effort  to  acquire  health  by 
cold  baths,  douches,  massage,  and  by  a  cleverly  combined  diet, 
or  by  a  pedantic  regulation  of  the  habits  of  life.  To  attend 
to  all  these  things  makes  one  something  of  a  hypochondriac — 
a  "  salutista,"  as  the  Italians  say.  They  keep  on  looking  after 
one's  physical  health,  and  make  one's  moral  happiness  depend 
upon  it.  Such  preoccupation  is  selfish  in  its  nature.  True 
hygiene  is  much  more  simple ;  it  consists,  first  of  all,  in  letting 
one's  self  live  with  unshaken  confidence  in  one's  resistance. 

The  healthy,  reasonable  man  has  good  habits.  He  eats  at 
regular  hours  all  the  foods  on  an  ordinary  table  without  any 
limitations  and  without  theories  as  to  their  digestibility;  he 
ought,  at  a  pinch,  to  be  sufficiently  easy  in  his  mind  regarding 
his  health  to  allow  himself  an  occasional  digression;  he  goes 
to  bed  more  or  less  early,  according  to  his  situation  and  the 
habits  of  life  in  which  he  lives,  and  he  has  no  fear  if  his 


459 

habits  are  upset  for  a  day;  he  looks  after  the  cleanliness  of 
his  skin  without  becoming  fanatical  on  the  subject  of  cold 
water;  he  does  not  become  intoxicated,  nor  does  he  do  any- 
thing that  might  be  hurtful  to  him ;  he  is  neither  weak-minded 
nor  pedantic ;  he  enjoys  life  fully. 

Intellectual  hygiene  is  just  as  simple.  One  must  be  inter- 
ested in  everything,  develop  his  aptitude,  and  learn  how  to 
live  his  life  intensely.  "  One-sidedness  "  of  tastes  and  aspi- 
rations is  dangerous;  it  is  in  itself  a  defect,  and  it  increases 
fatigue  by  concentrating  activity  on  a  single  subject.  I  con- 
sider the  proper  precept  for  mental  hygiene  to  be :  "I  am  a 
man;  therefore  all  human  interests  are  my  interests"  (Homo 
sum  ct  nihil  lutinani  a  me  alien um  puto). 

I  have  no  fear  of  overstrain,  whether  it  be  physical  or  in- 
tellectual, if  it  is  only  free  from  the  emotional  element  which 
is  the  result  more  than  anything  else  of  ambition.  I  prefer  in- 
tellectual and  moral  development  to  sport,  which  makes  ath- 
letes and  not  men.  The  grosser  instincts  grow  more  easily 
in  that  state  of  animal  well-being  which  is  induced  by  phys- 
ical exercise.  It  gives  me  no  pleasure  to  see  our  young  men 
and  girls  bent  over  their  bicycles,  our  Alpine  climbers  rigged 
out  like  Tartarin,  nor  to  see  the  daily  papers  giving  the  results 
of  all  sorts  of  matches,  such  as  pedestrian  contests,  football 
games,  tennis,  and  all  the  rest. 

I  in  no  wise  deny  the  advantages  or  free  movement  in  the 
open  air,  which  strengthens  the  muscles,  stimulates  the  or- 
ganic functions,  and  develops  energy.  But  I  believe  that  one 
can  get  too  much  of  this,  and  that  in  our  century,  where  we 
overdo  instruction  and  one  crowds  the  program,  it  would  be 
better  to  reserve  some  time  for  healthful  rest,  which  would 
give  us  time  for  reflection  and  meditation.  The  moral  tone 
would  be  improved  by  it.  It  is  this  moral  hygiene  which 
seems  to  me  to  be  neglected  more  than  anything  else.  We 
find  everywhere  a  certain  discontent  and  sad  pessimism,  which 
reacts  on  the  physical  health. 

In  repeating  the  adage,  "  A  sound  mind  in  a  sound  body  " 
(Metis  sana  in  corpore  sano),  one  would  perhaps  be  inclined 
to  think  that  to  care  for  the  body  is  all  that  is  necessary  in 


460  PSYCHIC   TREATMENT 

order  to  have  a  sound  mind.  It  is  the  sound  mind  which  the 
more  often  creates  the  healthy  body,  not  that  it  suppresses 
actual  disease  (it  has  not,  alas!  such  power),  but  because  it 
gives  us  strength  to  neglect  our  diseases  and  to  live  as  tho 
they  did  not  exist.  For  that  one  must  adopt  the  motto,  "  Never 
say  die,"  as  the  Jesuit  Father  put  it  who  was  cured  of  a  serious 
neurasthenia  and  recovered  his  power  to  act. 

I  often  say  to  such  patients :  "  One  only  needs  a  few 
pigeonholes  for  the  diseases  which  may  attack  us,  and  we 
must  try  to  always  keep  them  empty ;  so  we  need  a  huge  waste- 
basket  for  ailments,  in  order  that  we  may  deliberately  throw 
all  our  diseases  into  it."  We  must  desire  to  be  in  good  health 
and  persist  in  believing  in  our  strength,  even  when  we  feel 
weak.  We  must  recognize  by  calm  reason  the  necessity  for 
adapting  our  lives  to  our  condition.  Whatever  may  be  our 
fate,  we  must  cling  to  the  feeling  that  we  are  equal  to  the 
task,  and  that  we  have  enough  strength  in  reserve  to  overcome 
all  obstacles.  This  is  a  question  of  moral  resistance  and  not 
of  physical  robustness. 

I  will  close  with  a  few  lines  taken  from  my  pamphlet  on 
"  The  Influence  of  the  Mind  on  the  Body  " :  "  It  is  in  their  own 
education  that  patients  ought  to  seek  their  cure,  and  that  people 
in  good  health  should  find  their  safeguard  against  nervousness. 
One  ought  to  begin  by  little  things,  in  the  excellent  habit  of 
neglecting  one's  trifling  ailments,  and  of  going  bravely  forward 
without  being  too  much  concerned  for  one's  comforts.  With 
age,  preoccupations  increase.  Practical  life  brings  all  kinds 
of  annoyances  to  us.  Here  is  a  new  occasion  to  regulate  our 
sensibility,  and  voluntarily  to  create  an  optimistic  disposition, 
which  makes  us  take  hold  of  everything,  as  it  were,  by  the 
right  end. 

"  Thus  if,  when  we  reach  certain  maturity  of  mind,  we 
have  been  able  in  some  degree  to  create  this  precious  state, 
our  aspirations  ought  to  be  raised  higher,  and  we  ought  to 
consider  the  duties  which  our  presence  in  the  world  brings 
to  us,  and  our  relations  with  our  fellow  men.  We  thus  see 
clearly  that  our  chief  preoccupation  should  be  the  constant 
perfection  of  our  moral  ego. 


OF  NERVOUS   DISORDERS         461 

"  In  the  absence  of  all  theistic  conceptions  and  all  impera- 
tive morality,  the  thinker  experiences  the  unspeakable  dis- 
comfort which  results  from  a  life  where  selfish  preoccupations 
are  dominant.  To  find  inner  happiness  and  health,  he  must 
turn  his  attention  away  from  himself  and  interest  himself  in 
others.  Altruism  must  take  the  place  of  natural  egoism.  We 
can  not  go  too  far  in  this  tendency,  for  we  run  very  little  risk 
of  forgetting  ourselves  altogether.  Do  you  not  think  so? 

"  In  this  domain  of  moral  superiority,  our  moral  progress 
in  everything  is  as  certain  as  in  this  mental  hygiene,  which 
we  ought  to  use  to  oppose  our  physical  illnesses  and  annoy- 
ances. Thus  we  have  need  here  of  all  moral  helps. 

"  Those  to  whom  the  nature  of  their  minds  still  permits 
a  childlike  faith  will  find  strength  in  their  religious  convic- 
tions, in  proportion  as  they  are  living  and  sincere. 

"  Those  whose  reflections  lead  them  inevitably  to  free 
thought  will  find  in  themselves,  in  a  stoicism  stripped  of 
egoism,  the  strength  to  resist  all  that  life  brings  to  us. 

"  Unfortunate  are  they  who  are  indifferent,  who  seek 
nothing  but  the  satisfaction  of  their  material  desires! 

"  It  is  dangerous  to  go  through  life  without  either  re- 
ligion or  philosophy.  I  am  tempted,  without  casting  any  re- 
flection on  believers,  to  say,  more  simply,  '  without  philosophy,' 
for  religion  itself  can  be  efficacious  only  so  far  as  it  succeeds 
in  bestowing  upon  the  individual  who  believes  a  philosophy  of 
life.  Religion  or  philosophy — it  matters  little  which  flag  one 
marches  under,  provided  that  it  is  held  bravely  on  high ! " 

Let  one  display  the  legend :  "  Master  of  myself !  "  and  pa- 
tients will  follow  it  to  victory. 


INDEX 


463 


INDEX 


PACE  »ACE 

A  Conclusions 461 

Concomitance 48,  86 

Albuminuria 326  Concomitant  cerebration    ....   37, 40 

Amaurosis 178        Conrad,  Dr 398 

Anemia,  as  cause  of  nervousness  .    444        Conservation   of   energy 39 

Anesthesias   of   hysteria 177  Constipation,  habitual     ....   263,  291 

Anorexia,    mental 351        —  treatment  of 260,  295 

Antisepsis      12  Contagion,    hjsterical     .    .    .    .    174,351 

Antispasmodics 347        Contractures,  permanent 371 

Appetite,    psychic 288  Contradictions   in   nervous   patients  164 

Aphonia,   nervous 314        Contradiction,    spirit   of 354 

Arthritism,  as  cause  of  nervousness  445  Conviction    of   cure    .    .    .   --^7,  315,  358 

Asepsis 12        —  of  helplessness 319,  377 

Astasia-abasia 374       Convulsions       348 

—  syndrome 378       Counter-suggestion       296 

Asthenopia 163        Cramps,    functional 361 

Atavism      65       Credulity 215 

Athletics    overdone 459        Criminals,    treatment   of 73 

Atmospheric    pressure 137        Criminal  trials,  actual 77 

Automatism 117,  150 ideal 78 

Autonomy   of  the   moral   being  .    .      37  Cure,  conviction  of    ...   227,315,358 

Autosuggestion 31,  112 

—  in   dream 374  ~ 

T> 

Dallemagne 203 

Babinski's    sign 231        P«  5°n*ld,. 36 

Backward    children 70        £e   Candohe 63 

Bacteriology                                                 13  Degeneracy,   abuse  of  term      ...    203 

Barras    . 20, 261,  «62        ~  corporal  stigmata  of 202 

Basedow's  disease 1 3,  25,  306  ~  definition  of   .    .                    .            198 

Beard    G                                                      18  Degeneracies,      mental,      Magnan  s 

Bechterew'    '.'.'.'.'.'.'.'.'.'.'.    1 08  synopsis      .    .    ....    -    .    ...    200 

Berkeley                                                       38  Degenerative    mental    disease,    Mo- 

Bernadette  '    212  rel>?  classification 199 

Bernheim   .    .'    .'    .'    .'    ."    .'    .'    '16.215,219  {OS™?    '    '    '65.  202,  236,  274,  276, 377 

Bodily  diseases  and   nervous  coun-  IJelinum 20,  348 

terparts      105        Dementia 199 

"Born  criminal" 74       ~  pr*c?x      ••.',. 33f 

Braid  21*        Depression,  periodic ^  .    436 

Brain      '.    '.    '.'.'.'.'.    '.'.'.    .    .    .     81        Descartes 36,221 

—  digestive   troubles  in  disease  of  261        Ueslon .    214 

Briquet       14,28        Determinism 32,48,51,54 

Brissaud 360,363,366  £.H,Vlst.      '..V'   ,'    \  '    •    • .'    '    •    '      35 

Bromide .    .   30,  33  D«thesIS,    difficult    to   combat     .    .   446 

Broussais 261,262,414        £H*rrh.ea-    n.erfvous      279,281 

gur(]  .    .   214        Digestive    disturbances      250 

in  brain   diseases 261 

Disequilibrium,  mental 353 

C  Dogmatism 109 

Dreams 342 

Capo    d'Istria 96        Drug  therapy 452 

Cardiac    arythmia 307        Dualistic    spiritualism 89 

Cartesian  dualism 155        Du  Bois,   Reymond 37 

Centrifugal  motor  phenomena    ...     82       Duty 51 

Centripetal  sensory  stimulus      ...      82        Dynamogi-ny 124 

Charcot       .    .    .  14,  15,  181,214,363,440        Dynamophany 129 

Chaslin 24        Dyspeptics,   treatment  of 265 

Cheilophagia 364  Dyspepsia,    diagnosis   of   nervous  .    263 

Circulation,    disturbances   of    ...   305        Dyspnea,   nervous 3:1 


464 


INDEX 


E  Hysterical   anesthesias 177 

—  contagion 174,  35 1 

Education    of    reason    ...   35,  57,  210        —  fever 183 

Education    vs.    heredity 206        —  paraplegia 374 

Electrotherapy      140        Hysterogenic  zones       348 

Emotion 147        Hysteroneurasthenia 177,  357 

—  ideogenic  origin  of .148  j 

—  psychic 150 

Emotionalism,  exaggerated  ....  144  Ideogenic  origin  of  emotion  ...  148 

Emotional  tendency 151 of  mental  states 87 

Epilepsy 349  Illness  or  fault? 42,  67 

Ergograph 124  Illusions,  sensorial no 

Erotic  life  of  women 329  Illustrative  cases,  agoraphobia  .  .  364 

Etiology  of  psychoneuroses  .  .  .  439 mental  anorexia 252 

aphonia  315 

F  articular  neurosis 393 

astasia 378 

Fatalism 51,55 hysterical  astasia-abasia  .  .  377 

Fatigability 120 aversion  to  friends  ....  437 

—  abnormal      361 cardiac  troubles 308 

Fatigue      135,  122 colitis 297 

—  emotional 154       —  —  constipation 299 

—  intellectual       153 contradictions  in  nervous  pa- 

—  muscular      120  tients       164 

—  physical 153 conviction    of    cure    ....   228 

Fear 149 convulsions 350 

Fere' 122,  136,  153 cramps 368 

Fever,    hysterical 183 nervous  diarrhea,   etc     .    .    .    281 

Fixed  idea 206 dyspepsia   and  anorexia     .    .    417 

—  cultivation   of 259 nervous    dyspnea 312 

—  produced    by    physician's    words  232 fixed    idea    from    physician's 

Flournoy 48  words 232 

Forel       220 functional    cramp 362 

Food,  influence  of 142 gastro-intestinal   trouble    298,  413 

Free  will 48,  52 hyperesthesia 393 

Freud 342 hysteria 351 

Functional  disturbances 250 hysteria  with  multiple  symp- 

—  cramps      361  toms 401 

—  disorders,   real 258 hysterical  paraplegia  ....    375 

influence   of   physicia  n's 

G  words 376 

insomnia 339~34i 

Gastric    hypochondria 259 isolation 240 

Glycosuria 326 melancholia 186,  191 

Grasset       216,  358,  374 melancholic  neurasthenia  .    .   425 

Grasset's  diagram 217 motor   troubles 379 

—  "  polygon         220 nervous    pains 395 

Guyau 57 neurasthenia      ..._....   432 

neurasthenic    physician      .    .418 

H  420, 421 

overfeeding 270,  272 

Hallucination 20 periodic   depression     ....   449 

Happiness      64 pollakiuria 325 

Hasty  conclusions no,  115 psychic  emotion 150 

Heinroth 443 psychoneurosis     with     multi- 
Heredity    65,  204,  442            pie  symptoms 388 

—  corrected  by  psychotherapy    .    .    206 rectal    pain 300 

Herpetism,  as  cause  of  nervousness      445 sensitiveness   to   noise    ...    415 

Hippocrates 12 spirit  of  contradiction   ...    354 

Hygiene,  public  and  private    .    .    .    .458 success    attained    slowly    .    .   246 

Hypochondria     ....   18,184,188,457 tic 365 

—  gastric      259       Impotence,    psychic 329 

Hypnosis,  defined  by  Grasset  .    .    .    219  Imprudent  remarks  of  physicians  .   376 

Hypnotizers      ....     30,117,214,317        Incontinence  of  urine 321 

Hypotaxia      31 treatment    for 322 

Hysteria 15,  1 8  Inconvenience     of     diagnostic     re- 

—  a  mental  disease 221  searches  of  gastro-therapeutics    .    270 

—  epidemic    of 109        Infantilism,    psychic 175 

—  major 181        Intellect  of   hysterics 175 

—  not   a   morbid   entity 180        Internal  medicine 13 

—  origin   of 28 twentieth  century 452 

—  as  simulating  tuberculosis  ...    182  Influence  of  mind  on  body      .   447,  460 

—  stigmata    of 172  Intestine,  influence  of  morale  upon   287 

—  with  multiple  symptoms  ....   401        —  training  of 303 


INDEX 


465 


Irrationalism 15* 

Irons       145 

Insanity,  by  transformation  of  cer- 
tain neuroses 199 

—  hereditary 199 

—  idiopatbic 199 

—  sympathetic 199 

—  toxic 199 

Insomnia 334 

—  pathogeny  of 337 

—  prolonged 343 

—  treatment  of 338 

Isolation 236,  266,  456 

—  effect   of      239 


Tames,    W 144 

Tourdam 41 

Justice 59 


Kraepelin 188 

Krause,   "  Suggestor  " 117 

Kronecker,    Professor 289 


PAGE 

"  Mono-surerstition  " 221 

Montaigne' 112 

Moral  authority 91 

—  courage 43 

—  ideas     that     engender     material 
activity 89 

—  influence       41,  209 

Moral    orthopedia 64,  69 

difficulties   of 71,  79 

—  treatment 30 

of  psychopathies 95 

value    of 412 

Morality 60 

—  pathological  lack  of 437 

Morel      199,  204 

Mosso 122,  124 

Motives      50 

Motor    impulse 51,  57 

Muscles      80 

Myoclonias 208,  360,  367 

Myxedema 13 

N 


Nahlowsky 145 

Nancy 16,  216 

Narcotics    useless 336 

•"  Naville 40,  49 

Lancereaux 44«  Nervous  crises     .    ••••••    •    •    347 

Lange                                                  j44  ^jg  Nervousness,   a   psychic   disorder    .    250 

La   Salpetriere'    '.'.'.'.'.'.    \      16,  274       ~  symptoms  of 249 

Laxatives  inefficient 292        £eural£ias 0  •    •    2o8 

Leibnitz      38       Neurasthenia 18,20,159 

Lehmann 145  ~  melancholic      .........    425 

Liberty                                             45   47   58  Neuroses,   classification  of    ....      22 

Liibauit    '.'.'.'.'.'.'.'.  '16,2*1 5, 219     ;r  Haumalic 176,357 

Lister      12        Nordau,   Max    .  203 

Local  examinations,  bad  effects  of  409       Nosographical  analyse 207 

Logical    reflection 435 

Lombroso 74  O 

Lourdes 211,372,380 

Louyer-Yillirmay 28        Oliguria 322 

Luys 214       Onanism 328 

,,  Onychophagia 364 

Opinion      147 

Magnan      199        Opotherapy 13 

Magnan's    synopsis    of    mental    de-  Organic  lesions 14 

generacies 200        Overfeeding       267 

Major  hysteria 181        ~  effect    of 23»,  269 

—  neuroses       15 

Malade  imaginaire      188  P 

Manto 274 

"  Mastkur  "       236  Pain,  a  psychic  phenomenon   .    .    .    392 

Material     activity     engendered     by  —  nervous 395 

moral  ideas 90  Parallelism,  psychophysical   ....    162 

Meige,   Henri 363, 366       Paralysis 374 

Melancholia      18,184,457       —  suggested 115 

—  prognosis 191        Paranoia 32 

Menopause 332        Paraplegia,    hysterical 374 

Menstruation 331        Paresis,  general 93 

Mentality,  abnormal 69       Parmenides 38 

• —  change  of 89,233,415       Pasteur 12 

—  high  idea   of   human 436        Pavlow 288 

Mental  predisposition 158        Peripheral  stimuli 146 

Mental     representations,     influence  Periodic  depression 436 

on  intestine 278  Peristalsis    accelerated    by    mental 

intervention  of 141  representations 289 

Mesmer      31,  213        Persuasion 91,  108 

Metallotherapy 214        —  and  suggestion 216 

Milk  diet 267        Phobias       139 

Moebius 159       Phobonhobia      151 

Moliere      too,  188        Phosphaturia 326 

Monistic  conception 80  Physical  means  of  treatment  ...     13 


466 


INDEX 


PAGE  PAG* 

Physicians,  neurasthenic 418       Spasmodic  conditions 371 

Physiologists,    mistakes   of    ....      84        Specifics 453 

Physiology    and    psychology,    merg-  Spontaneity,  lack  of,  in  man   ...      81 

ing   of 85  Stigmata  of  degeneracy    .    .    .   200,  202 

Pinel 96,  435  —  of  nervousness,  mental   ....    106 

Plato 45        Stimuli,   peripheral      146 

Pollakiuria 323  Subjection  of  mind  to  certain  dis- 

"  Polygon  "  of  Grasset 220  eases 93 

Positivism      32  Success  dependent  upon  physician's 

Predestined  harmony      .._....      38  mentality 357 

Predisposition,   psychopathic     .    .    .    442        Suffering  is  psychic 455 

Psychasthenia I57>  J66        Suggestibility 17,  215 

Psychic    equivalents    . 94       —  exaggerated 107,  152 

—  influences,  predominance  of   .    .    251        —  normal      219 

—  symptoms  of  nervousness   ...    103        Suggestion 16 

—  treatment,  neglect  of 99        —  inverse 232 

Psychomotor  discipline 366       —  medicative 315 

Psychoneurosis  with  multiple  symp-  —  verbal 215 

toms,    case   of      388        —  with  medicine 213 

Psychoneuroses 25,  31        —  and  persuasion .    216 

—  etiology  of 439        Suggestpr,  Krause 117 

—  therapeutics  of 209        Superstition       433 

Psychopathic    conditions 455        Surgery      12 

Psychophysical   parallelism    ....    162        —  psychotherapy  in 452 

Psychoses       25        —  twentieth    century 452 

Psychotherapy 17,  33.  4'.  45        Sydenham      24 

—  affections   amenable   to    ....      26        Syllogisms,    false 139 

—  in   mental    disease 225 

—  in   organic   disease 224  .j. 

—  in  surgery 223 

—  introduced .  by    Pinel 96  Tachycardia,    emotional     .    .    .   305, 307 

—  plus  medicine 2<  _  in'  incipient   tuberculosis     .    .    .    3«6 

—  rational     . a  Tarascon 211 

—  vs.  heredity 200  Tartuffe                                                         61 

—  without  physical  measures  ...   425  Thyroid  giand  |                                         ,3 

£°iy."»a   ; 3"     Tfcy       * 6£ 

Punishment 73         _  mentality   in 366 

P  Tiqueurs        363 

Tissie      122,  153 

Rational   psychotherapy     .    .    ...   223  Toutouse,  causes 'of  nervousness"    !   440 

Reason,  education  of  the      .    35,  57,  210        Tourette   Giles  de  ia 363 

Religious   faith 210,244       Traumatic   neuroses 176,357 

Regeneration  vs.   degeneracy    ...    205  Tuberculosis   simulated  by   hysteria   182 

Responsibility 45.  52,  5°        Tuke,  Hack ....    Ill 

—  moral 59  Twentieth   center?  'medicine    !    .    .   452 

—  social 59 

Rest  cure 236  TI 

—  in  bed 266 

—  effect  of 236  Urinary   functions,   disturbances  of  319 

S  v 

Sahli    Professor 213        Verba,  suggestion lg 

St.    VltUS     dance 24  Virrhow 

Schwetchine,   Madame 154  Volitior                                        "50   sx    55 

Science,  limitations  of 248  Voet     Oscar   '    '    '                                   220 

Seneca 394 

Sensations 133  ... 

Sensibilities,  abnormal   ....    138,  169 

Sens"oriaiymusions  '.    '.    !!.'.'!!    no  Wavering  diagnosis,  bad  effects  of  408 

ScrKi                                                     .    .    144  Weir  Mitchell  treatment   .    .    .   234,  265 

Serotherapy   '.'.'.'.'. 13       —  -    ~  modified 235 

Sexual   life 327        Wetterstrand 220 

Sganarelle 161        Will     .    .    .    .    . .    .   45,  58 

Sleep,  psychology  of 343  —  intervening  in  automatic  action  302 

Somatic  origin  of  mental  states  .    .      87        Worcester      US 

Spasms  ...........  208, 260       Wundt 145 


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